Outcome After Implantation of a Cardioverter-Defibrillator in Patients With Brugada Syndrome
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Published:2013-10-15
Issue:16
Volume:128
Page:1739-1747
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ISSN:0009-7322
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Container-title:Circulation
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language:en
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Short-container-title:Circulation
Author:
Sacher Frédéric1, Probst Vincent1, Maury Philippe1, Babuty Dominique1, Mansourati Jacques1, Komatsu Yuki1, Marquie Christelle1, Rosa Antonio1, Diallo Abou1, Cassagneau Romain1, Loizeau Claire1, Martins Raphael1, Field Michael E.1, Derval Nicolas1, Miyazaki Shinsuke1, Denis Arnaud1, Nogami Akihiko1, Ritter Philippe1, Gourraud Jean-Baptiste1, Ploux Sylvain1, Rollin Anne1, Zemmoura Adlane1, Lamaison Dominique1, Bordachar Pierre1, Pierre Bertrand1, Jaïs Pierre1, Pasquié Jean-Luc1, Hocini Mélèze1, Legal François1, Defaye Pascal1, Boveda Serge1, Iesaka Yoshito1, Mabo Philippe1, Haïssaguerre Michel1
Affiliation:
1. From the Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, L’Institut de Rythmologie et de Modelisation Cardiaque, INSERM 1045, Bordeaux, France (F.S., A.D., C.L., M.E.F., N.D., A.D., P.R., S.P., A.Z., P.B., P.J., M.H., M.H.); Institut du Thorax, CHU de Nantes, Nantes, France (V.P., J.-B.G.); CHU de Toulouse, Toulouse, France (P. Maury, A. Rollin); CHU de Tours, Tours, France (D.B., B.P.); CHU de Brest, Brest, France (J.M., S.M.); Tsuchiura Kyodo Hospital, Tsuchiura, Japan (Y.K., Y.I.); CHU de...
Abstract
Background—
Implantable cardioverter-defibrillator indications in Brugada syndrome remain controversial, especially in asymptomatic patients. Previous outcome data are limited by relatively small numbers of patients or short follow-up durations. We report the outcome of patients with Brugada syndrome implanted with an implantable cardioverter-defibrillator in a large multicenter registry.
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.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Physiology (medical),Cardiology and Cardiovascular Medicine
Reference22 articles.
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