title: Predictors of Ventricular Arrhythmias and Sudden Death in a Québec Cohort With Brugada Syndrome.
abstract: Patients with Brugada syndrome (BrS) are at risk for ventricular arrhythmias (VAs) and sudden death. Identification of high-risk individuals beyond those with syncope or resuscitated sudden death remains a major challenge.
  
  
  
  We assessed the value of clinical, electrophysiological, and electrocardiographic (ECG) features, including depolarization and repolarization metrics, in predicting arrhythmic events and sudden death in consecutive patients with BrS diagnosed between 2002 and 2013 in Quebec, Canada. Qualifying electrocardiograms with the highest type 1 ST-segment elevations were reviewed and analyzed by 2 electrophysiologists who were blinded to clinical history. Survival analyses were adjusted for Firth bias correction and left truncation.
  
  
  
  A total of 105 patients, 79.8% of whom were men, were diagnosed with BrS at a mean age of 46.2 ± 13.3 years and were followed for 59.6 ± 16.4 months. Ten (9.5%) had a history of cardiac arrest, 37 (35.2%) had syncope, and 7 (6.7%) experienced 20 arrhythmic events during follow-up, all consisting of appropriate ICD therapy (7 antitachycardia pacing; 13 shocks). In multivariate Cox regression analyses, a spontaneous type 1 electrocardiographic (ECG) pattern (hazard ratio [HR], 10.80; 95% confidence interval [CI], 1.03-113.87; P = 0.0476), maximal T peak-end (Tp-e) duration ≥ 100 ms (HR, 29.73; 95% CI, 1.33-666.37; P = 0.0325), and QRS duration in lead V6> 110 ms (HR, 15.27; 95% CI, 1.07-217.42; P = 0.0443) were independently associated with VAs or aborted sudden cardiac death.
  
  
  
  In a multicentre cohort with BrS from Quebec, Canada, VAs and sudden death were independently associated with standard 12-lead ECG features, including a spontaneous type 1 pattern, depolarization (QRS in lead V6), and repolarization (maximal Tp-eduration) criteria.
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada. Electronic address: lena.rivard@umontreal.ca.
authors.forename: Lena
authors.initials: L
authors.lastname: Rivard
authors.affiliation: Department of Medicine, Québec Heart and Lung Institute, Université Laval, Québec City, Québec, Canada.
authors.forename: Antoine
authors.initials: A
authors.lastname: Roux
authors.affiliation: Department of Medicine, Québec Heart and Lung Institute, Université Laval, Québec City, Québec, Canada.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Nault
authors.affiliation: Department of Medicine, Québec Heart and Lung Institute, Université Laval, Québec City, Québec, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Champagne
authors.affiliation: Department of Medicine, Centre Hospitalier Université de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec, Canada.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Roux
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Rafik
authors.initials: R
authors.lastname: Tadros
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Mario
authors.initials: M
authors.lastname: Talajic
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Julia
authors.initials: J
authors.lastname: Cadrin-Tourigny
authors.affiliation: Montréal Health Innovations Coordinating Center (MHICC), Montréal Heart Institute, Montréal, Québec, Canada.
authors.forename: Azadeh
authors.initials: A
authors.lastname: Shohoudi
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Blandine
authors.initials: B
authors.lastname: Mondésert
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Denis
authors.initials: D
authors.lastname: Roy
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Macle
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Andrade
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Katia
authors.initials: K
authors.lastname: Dyrda
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Dubuc
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Guerra
authors.affiliation: Department of Medicine, Québec Heart and Lung Institute, Université Laval, Québec City, Québec, Canada.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Sarrazin
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Bernard
authors.initials: B
authors.lastname: Thibault
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada; Montréal Health Innovations Coordinating Center (MHICC), Montréal Heart Institute, Montréal, Québec, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
mesh_terms: D053840:Brugada Syndrome / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011792:Quebec / Q000453:epidemiology; D014693:Ventricular Fibrillation / Q000401:mortality / Q000503:physiopathology*