Long-term follow-up in patients with presumptive Brugada syndrome treated with implanted defibrillators

INTRODUCTION: Risk stratification for patients with suspected Brugada syndrome (BS) remains difficult. Implantation of cardioverter-defibrillators (ICDs) in high-risk patients provides continuous long-term arrhythmia protection.

METHODS: Data of 33 consecutive patients undergoing ICD implantation after BS evaluation between 1995 and 2008 were reviewed.

RESULTS: There were 30 (91%) men and 3 (9%) women (46.4 ± 11.7 years). Type I Brugada was noted in 18 (54.5%), type II in 12 (36.4%) patients, and ST elevation after drug challenge in 3 patients (9.1%). Three patients had prior cardiac arrest; 70% a history of syncope; and 56% ventricular arrhythmias at the electrophysiology study. During 7.9 ± 3.6 years of follow-up, 2 patients with prior arrest received appropriate ICD shocks. None of the 30 patients without prior arrest had a sustained arrhythmia detected. ICD-related adverse effects occurred in 11 (33%) patients, including inappropriate shocks in 5 (15%). Eight patients (24%) developed 11 major device-related complications including subclavian vein thrombosis (1), pericardial effusion (1), lead fracture (2), and infection (2); in 4 patients the only complication was premature battery depletion that required early ICD replacement; however, some of these complications such as lead fractures and early battery depletion may not be specific for this patient cohort and may not repeat in the future.

CONCLUSION: Risk stratification for patients with BS for primary prevention remains challenging. The low risk of arrhythmic events that is exceeded by ICD-related adverse effects should inform discussions with patients who do not have a prior history of cardiac arrest.