Outcome after implantation of a cardioverter-defibrillator in patients with Brugada syndrome: a multicenter study-part 2.
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Sacher Frédéric, Probst Vincent, Maury Philippe, Babuty Dominique, Mansourati Jacques, Komatsu Yuki, Marquie Christelle, Rosa Antonio, Diallo Abou, Cassagneau Romain, Loizeau Claire, Martins Raphael, Field Michael E, Derval Nicolas, Miyazaki Shinsuke, Denis Arnaud, Nogami Akihiko, Ritter Philippe, Gourraud Jean-Baptiste, Ploux Sylvain, Rollin Anne, Zemmoura Adlane, Lamaison Dominique, Bordachar Pierre, Pierre Bertrand, Jaïs Pierre, Pasquié Jean-Luc, Hocini Mélèze, Legal François, Defaye Pascal, Boveda Serge, Iesaka Yoshito, Mabo Philippe, Haïssaguerre Michel
Аннотация
METHODS AND RESULTS: A total of 378 patients (310 male; age, 46±13 years) with a type 1 Brugada ECG pattern implanted with an implantable cardioverter-defibrillator (31 for aborted sudden cardiac arrest, 181 for syncope, and 166 asymptomatic) were included. Fifteen patients (4%) were lost to follow-up. During a mean follow-up of 77±42 months, 7 patients (2%) died (1 as a result of an inappropriate shock), and 46 patients (12%) had appropriate device therapy (5±5 shocks per patient). Appropriate device therapy rates at 10 years were 48% for patients whose implantable cardioverter-defibrillator indication was aborted sudden cardiac arrest, 19% for those whose indication was syncope, and 12% for the patients who were asymptomatic at implantation. At 10 years, rates of inappropriate shock and lead failure were 37% and 29%, respectively. Inappropriate shock occurred in 91 patients (24%; 4±4 shocks per patient) because of lead failure (n=38), supraventricular tachycardia (n=20), T-wave oversensing (n=14), or sinus tachycardia (n=12). Importantly, introduction of remote monitoring, programming a high single ventricular fibrillation zone (>210-220 bpm), and a long detection time were associated with a reduced risk of inappropriate shock.
CONCLUSIONS: Appropriate therapies are more prevalent in symptomatic Brugada syndrome patients but are not insignificant in asymptomatic patients (1%/y). Optimal implantable cardioverter-defibrillator programming and follow-up dramatically reduce inappropriate shock. However, lead failure remains a major problem in this population.