Author + information
- Received May 15, 2017
- Revision received August 16, 2017
- Accepted August 17, 2017
- Published online October 9, 2017.
- Jaime Hernandez-Ojeda, MD, PhDa,b,∗ (, )
- Elena Arbelo, MD, PhDa,b,
- Roger Borras, MSca,b,
- Paola Berne, MDa,b,
- Jose M. Tolosana, MD, PhDa,b,
- Andrea Gomez-Juanatey, MDa,b,
- Antonio Berruezo, MD, PhDa,b,
- Oscar Campuzano, BSc, PhDc,d,e,
- Georgia Sarquella-Brugada, MD, PhDf,
- Lluis Mont, MD, PhDa,b,
- Ramon Brugada, MD, PhDc,d,e,g and
- Josep Brugada, MD, PhDa,b,f
- aArrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- bIDIBAPS, Institut d’Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- cCardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
- dMedical Science Department, School of Medicine, University of Girona, Girona, Spain
- eCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- fArrhythmia Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- gCardiology Service, Hospital Josep Trueta, Girona, Spain
- ↵∗Address for correspondence:
Dr. Jaime Hernandez-Ojeda, Hospital Clínic de Barcelona, C/ Villarroel, 170, 6º, escala 3, 08036 Barcelona, Spain.
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.
This work was funded by Concession Instituto de Salud Carlos III, FIS PI16/01203, co-funded by ERDF/ESF, “Investing in Your Future”; Concession Instituto de Salud Carlos III, FIS_RETIC12, File Nº: RD12/0042/0044, Red Cardiovascular; Concession Agencia de Gestió d’Ajuts Universitaris i de Recerca (AGAUR) Generalitat de Catalunya, File Nº: 2014_SGR_471; Concession Instituto de Salud Carlos III, FIS_CIBER16, File Nº: CB16/11/00354, Centro de Investigación Biomedica en Red; and Concession Instituto de Salud Carlos III, FIS _PI14/01773, Obra Social “La Caixa”. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Hernandez-Ojeda and Arbelo contributed equally to this work.
- Received May 15, 2017.
- Revision received August 16, 2017.
- Accepted August 17, 2017.
- 2017 American College of Cardiology Foundation
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