Outcome after implantation of cardioverter defibrillator [corrected] in patients with Brugada syndrome: a multicenter Israeli study (ISRABRU)

Raphael Rosso, Aharon Glick, Michael Glikson, Abraham Wagshal, Moshe Swissa, Shimon Rosenhek, Israel Shetboun, Vladimir Khalamizer, Therese Fuchs, Munther Boulos, Michael Geist, Boris Strasberg, Michael Ilan, Bernard Belhassen et al.
Israel Medical Association Journal: IMAJ 2008, 10 (6): 435-9

BACKGROUND: Many electrophysiologists recommend implantable cardioverter defibrillators for patients with Brugada syndrome who are cardiac arrest survivors or presumed at high risk of sudden death (patients with syncope or a familial history of sudden death or those with inducible ventricular fibrillation at electrophysiologic study).

OBJECTIVES: To assess the efficacy and complications of ICD therapy in patients with Brugada syndrome.

METHODS: The indications, efficacy and complications of ICD therapy in all patients with Brugada syndrome who underwent ICD implantation in 12 Israeli centers between 1994 and 2007 were analyzed.

RESULTS: There were 59 patients (53 males, 89.8%) with a mean age of 44.1 years. At diagnosis 42 patients (71.2%) were symptomatic while 17 (28.8%) were asymptomatic. The indications for ICD implantation were: a history of cardiac arrest (n = 11, 18.6%), syncope (n = 31, 52.5%), inducible VF in asymptomatic patients (n = 14, 23.7%), and a family history of sudden death (n = 3, 0.5%). The overall inducibility rates of VF were 89.2% and 93.3% among the symptomatic and asymptomatic patients, respectively (P = NS). During a follow-up of 4-160 (45 +/- 35) months, all patients (except one who died from cancer) are alive. Five patients (8.4%), all with a history of cardiac arrest, had appropriate ICD discharge. Conversely, none of the patients without prior cardiac arrest had appropriate device therapy during a 39 +/- 30 month follow-up. Complications were encountered in 19 patients (32%). Inappropriate shocks occurred in 16 (27.1%) due to lead failure/dislodgment (n = 5), T wave oversensing (n = 2), device failure (n = 1), sinus tachycardia (n = 4), and supraventricular tachycardia (n = 4). One patient suffered a pneumothorax and another a brachial plexus injury during the implant procedure. One patient suffered a late (2 months) perforation of the right ventricle by the implanted lead. Eleven patients (18.6%) required a reintervention either for infection (n = 1) or lead problems (n = 10). Eight patients (13.5%) required psychiatric assistance due to complications related to the ICD (mostly inappropriate shocks in 7 patients).

CONCLUSIONS: In this Israeli population with Brugada syndrome treated with ICD, appropriate device therapy was limited to cardiac arrest survivors while none of the other patients including those with syncope and/or inducible VF suffered an arrhythmic event. The overall complication rate was high.

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