Patients With Brugada Syndrome and Implanted Cardioverter-Defibrillators Long-Term Follow-Up

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:70

Article

Hernandez-Ojeda, Jaime^1,2  Arbelo, Elena^1,2  Borras, Roger^1,2  Berne, Paola^1,2  Tolosana, Jose M.^1,2  Gomez-Juanatey, Andrea^1,2  Berruezo, Antonio^1,2  Campuzano, Oscar^3,4,5  Sarquella-Brugada, Georgia⁶  Mont, Lluis^1,2  Brugada, Ramon^3,4,5,7  Brugada, Josep^1,2,6 

[1] Univ Barcelona, Arrhythmia Sect, Cardiol Dept, Hosp Clin, Barcelona, Spain

[2] Inst Invest August Pi & Sunyer, IDIBAPS, Barcelona, Spain

[3] Univ Girona IDIBGI, Cardiovasc Genet Ctr, Girona, Spain

[4] Univ Girona, Med Sci Dept, Sch Med, Girona, Spain

[5] Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain

[6] Univ Barcelona, Arrhythmia Unit, Hosp St Joan Deu, Barcelona, Spain

[7] Hosp Josep Trueta, Cardiol Serv, Girona, Spain

关键词: appropriate shocks;    device-related complications;    primary prevention;    sudden death;    syncope;   

DOI  :  10.1016/j.jacc.2017.08.029

来源: Elsevier

【 摘 要 】

BACKGROUND Implantable cardioverter-defibrillator (ICD) indications for primary prevention in Brugada syndrome (BrS) are still debated. OBJECTIVES The authors investigated the long-term outcome after ICD implantation in a large cohort of BrS patients. METHODS Of a total of 370 patients with BrS in follow-up (age 43 +/- 14 years; 74% male), 104 patients (28.1%) were treated with ICDs. The authors analyzed the long-term incidence of shocks and complications. RESULTS An ICD was implanted for secondary prevention in 10 patients (9.6%) and for primary prevention in 94 patients (90.4%). After a follow-up of 9.3 +/- 5.1 years, 21 patients (20.2%) experienced a total of 81 appropriate shocks (incidence rate 2.2 per 100 person-years). The rate of appropriate shocks was higher in secondary prevention patients (p < 0.01). However, 4 of the 45 asymptomatic patients (8.9%) experienced appropriate ICD therapy, all with a spontaneous type 1 electrocardiogram and inducible ventricular arrhythmias. In the multivariable analysis, type 1 electrocardiogram with syncope (hazard ratio: 4.96; 95% confidence interval: 1.87 to 13.14; p < 0.01) and secondary prevention indication (hazard ratio: 6.85; 95% confidence interval: 2.29 to 20.50; p < 0.01) were significant predictors of appropriate therapy. Nine patients (8.7%) experienced 37 inappropriate shocks (incidence rate 0.9 per 100 person-years). Twenty-one patients (20.2%) had other ICD-related complications (incidence rate 1.4 per 100 person-years). Three patients (2.9%) died (1 electrical storm and 2 noncardiovascular deaths). CONCLUSIONS ICD therapy is an effective therapy in high-risk patients with BrS. However, it is also associated with a significant risk of device-related complications. Special care during ICD implantation, adequate device programming, and regular follow-up may allow reducing the number of adverse events. (C) 2017 by the American College of Cardiology Foundation.

【 授权许可】

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