Long-term follow-up in patients with presumptive Brugada syndrome treated with implanted defibrillators
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Long-term follow-up in patients with presumptive Brugada syndrome treated with implanted defibrillators. / Steven, Daniel; Roberts-Thomson, Kurt C; Inada, Keiichi; Seiler, Jens; Koplan, Bruce A; Tedrow, Usha B; Sweeney, Michel O; Epstein, Laurence E; Stevenson, William G.
In: J CARDIOVASC ELECTR, Vol. 22, No. 10, 10.2011, p. 1115-1119.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Long-term follow-up in patients with presumptive Brugada syndrome treated with implanted defibrillators
AU - Steven, Daniel
AU - Roberts-Thomson, Kurt C
AU - Inada, Keiichi
AU - Seiler, Jens
AU - Koplan, Bruce A
AU - Tedrow, Usha B
AU - Sweeney, Michel O
AU - Epstein, Laurence E
AU - Stevenson, William G
N1 - © 2011 Wiley Periodicals, Inc.
PY - 2011/10
Y1 - 2011/10
N2 - 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.
AB - 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.
KW - Adult
KW - Boston
KW - Brugada Syndrome/complications
KW - Death, Sudden, Cardiac/etiology
KW - Defibrillators, Implantable/adverse effects
KW - Electric Countershock/adverse effects
KW - Electrocardiography
KW - Electrophysiologic Techniques, Cardiac
KW - Female
KW - Humans
KW - Kaplan-Meier Estimate
KW - Male
KW - Middle Aged
KW - Patient Selection
KW - Prosthesis Failure
KW - Retrospective Studies
KW - Risk Assessment
KW - Risk Factors
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1111/j.1540-8167.2011.02075.x
DO - 10.1111/j.1540-8167.2011.02075.x
M3 - SCORING: Journal article
C2 - 21545364
VL - 22
SP - 1115
EP - 1119
JO - J CARDIOVASC ELECTR
JF - J CARDIOVASC ELECTR
SN - 1045-3873
IS - 10
ER -