Outcome after implantation of a cardioverter-defibrillator in patients with Brugada syndrome: a multicenter study

Frédéric Sacher, Vincent Probst, Yoshito Iesaka, Peggy Jacon, Julien Laborderie, Frédérique Mizon-Gérard, Philippe Mabo, Sylvain Reuter, Dominique Lamaison, Yoshihide Takahashi, Mark D O'Neill, Stéphane Garrigue, Bertrand Pierre, Pierre Jaïs, Jean-Luc Pasquié, Mélèze Hocini, Michèle Salvador-Mazenq, Akihiko Nogami, Alain Amiel, Pascal Defaye, Pierre Bordachar, Serge Boveda, Philippe Maury, Didier Klug, Dominique Babuty, Michel Haïssaguerre, Jacques Mansourati, Jacques Clémenty, Hervé Le Marec
Circulation 2006 November 28, 114 (22): 2317-24

BACKGROUND: Brugada syndrome is an arrhythmogenic disease characterized by an increased risk of sudden cardiac death (SCD) by ventricular fibrillation. At present, an implantable cardioverter-defibrillator (ICD) is the recommended therapy in high-risk patients. This multicenter study reports the outcome of a large series of patients implanted with an ICD for Brugada syndrome.

METHODS AND RESULTS: All patients (n=220, 46+/-12 years, 183 male) with a type 1 Brugada ECG pattern implanted with an ICD in 14 centers between 1993 and 2005 were investigated. ICD indication was based on resuscitated SCD (18 patients, 8%), syncope (88 patients, 40%), or positive electrophysiological study in asymptomatic patients (99 patients, 45%). The remaining 15 patients received an ICD because of a family history of SCD or nonsustained ventricular arrhythmia. During a mean follow-up of 38+/-27 months, no patient died and 18 patients (8%) had appropriate device therapy (10+/-15 shocks/patient, 26+/-33 months after implantation). The complication rate was 28%, including inappropriate shocks, which occurred in 45 patients (20%, 4+/-3 shocks/patient, 21+/-20 months after implantation). The reasons for inappropriate therapy were lead failure (19 patients), T-wave oversensing (10 patients), sinus tachycardia (10 patients), and supraventricular tachycardia (9 patients). Among implantation parameters, high defibrillation threshold, high pacing threshold, and low R-wave amplitude occurred, respectively, in 12%, 27%, and 15% of cases.

CONCLUSIONS: In this large Brugada syndrome population, a low incidence of arrhythmic events was found, with an annual event rate of 2.6% during a follow-up of >3 years, in addition to a significant risk of device-related complications (8.9%/year). Inappropriate shocks were 2.5 times more frequent than appropriate ones.

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