Author + information
- Received May 24, 2011
- Revision received July 29, 2011
- Accepted August 16, 2011
- Published online January 3, 2012.
- Silvia G. Priori, MD, PhD⁎,†,‡,⁎ (, )
- Maurizio Gasparini, MD§,
- Carlo Napolitano, MD, PhD⁎,‡,
- Paolo Della Bella, MD∥,
- Andrea Ghidini Ottonelli, MD¶,
- Biagio Sassone, MD#,
- Umberto Giordano, MD⁎⁎,
- Carlo Pappone, MD††,
- Giosuè Mascioli, MD‡‡,
- Guido Rossetti, MD§§,
- Roberto De Nardis, MD∥∥ and
- Mario Colombo, MS¶¶
- ↵⁎Reprint requests and correspondence:
Dr. Silvia G. Priori, Molecular Cardiology, IRCCS Salvatore Maugeri Foundation, Via Maugeri 10/10a, 27100 Pavia, Italy
Objectives The PRELUDE (PRogrammed ELectrical stimUlation preDictive valuE) prospective registry was designed to assess the predictive accuracy of sustained ventricular tachycardia/ventricular fibrillation (VTs/VF) inducibility and to identify additional predictors of arrhythmic events in Brugada syndrome patients without history of VT/VF.
Background Brugada syndrome is a genetic disease associated with increased risk of sudden cardiac death. Even though its value has been questioned, inducibility of VTs/VF is widely used to select candidates to receive a prophylactic implantable defibrillator, and its accuracy has never been addressed in prospective studies with homogeneous enrolling criteria.
Methods Patients with a spontaneous or drug-induced type I electrocardiogram (ECG) and without history of cardiac arrest were enrolled. The registry included 308 consecutive individuals (247 men, 80%; median age 44 years, range 18 to 72 years). Programmed electrical stimulation was performed at enrollment, and patients were followed-up every 6 months.
Results During a median follow-up of 34 months, 14 arrhythmic events (4.5%) occurred (13 appropriate shocks of the implantable defibrillator, and 1 cardiac arrest). Programmed electrical stimulation performed with a uniform and pre-specified protocol induced ventricular tachyarrhythmias in 40% of patients: arrhythmia inducibility was not a predictor of events at follow-up (9 of 14 events occurred in noninducible patients). History of syncope and spontaneous type I ECG (hazard ratio [HR]: 4.20), ventricular refractory period <200 ms (HR: 3.91), and QRS fragmentation (HR: 4.94) were significant predictors of arrhythmias.
Conclusions Our data show that VT/VF inducibility is unable to identify high-risk patients, whereas the presence of a spontaneous type I ECG, history of syncope, ventricular effective refractory period <200 ms, and QRS fragmentation seem useful to identify candidates for prophylactic implantable cardioverter defibrillator.
This study was partly supported by unrestricted educational grants from Medtronic and Boston Scientific. Dr. Priori is on the advisory board for Biotronik SE, Medtronic, and Boston Scientific. Dr. Gasparini is on the advisory board of St. Jude Medical. Dr. Della Bella is on the advisory board of St. Jude Medical and Biosense Webster. Dr. Pappone is on the advisory board of Biotronik, St. Jude Medical, and Stereotaxis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 24, 2011.
- Revision received July 29, 2011.
- Accepted August 16, 2011.
- American College of Cardiology Foundation