Europace Advance Access originally published online on February 4, 2009
Europace 2009 11(4):507-513; doi:10.1093/europace/eup006
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Brugada Syndrome
Risk stratification of the patients with Brugada type electrocardiogram: a community-based prospective study
1 Division of Cardiology, Cardinal Massaia Hospital, University of Torino, Corso Dante, 202, 14100 Asti, Italy; 2 Division of Cardiology, Azienda Ospedaliera Santi Antonio e Biagio, Alessandria, Italy; 3 Medical Statistics Unit, Department of Public Health and Microbiology, University of Torino, Torino, Italy; 4 Division of Cardiology, Ospedale Mauriziano, Torino, Italy; 5 Division of Cardiology, Ospedale di Rivoli, Rivoli, Italy; 6 Division of Cardiology, Ospedale S. Luigi, Orbassano, Torino, Italy; 7 Division of Cardiology, Ospedale Maggiore della Carità, Novara, Italy; 8 Division of Cardiology, Ospedale S. Croce e Carle, Cuneo, Italy; 9 Division of Cardiology, Ospedale di Vigevano, Vigevano, Italy
Aims: Risk stratification of patients with Brugada electrocardiogram (ECG) is being strongly debated. Conflicting results have been suggested from international registries, which enrolled non-consecutive cases, studied with different programmed electrical stimulation (PES) protocols. The aim of this study was to prospectively evaluate the incidence of arrhythmic events and the prognostic role of clinical presentation, ECG, and of a standardized PES protocol in consecutive cases from a community-based population.
Methods and results: A total of 166 consecutive patients (45 ± 14 years) with Brugada ECG were enrolled. Type 1 ECG was observed spontaneously in 72 (43%) and after pharmacological testing in 94 (57%). One hundred and three (62%) were asymptomatic, 58 (35%) had syncope, and five (3%) had a prior cardiac arrest. One hundred and thirty-five (81%) underwent PES with two extra stimuli up to ventricular refractoriness and 34% had ventricular fibrillation (VF) induced. Arrhythmic events occurred in nine patients at a mean follow-up of 30 ± 21 months (2.2 events per 100 person-year): in three (60%) patients with aborted sudden death (aSD), five (8.6%) of those with syncope, and one (1%) of the asymptomatic. The only predictors of events were a history of syncope or aSD (P = 0.02) and induction at PES (P = 0.004).
Conclusion: Clinical presentation is the most important parameter in the risk stratification of patients with Brugada ECG. Programmed electrical stimulation seems valuable, particularly in patients with previous syncope.
Key Words: Sudden death, Arrhythmia, Electrophysiology, Genetics, Syncope
* Corresponding author. Tel: +39 0141 487121, Fax: +39 0141 487134, Email: carlagiustetto{at}mac.com
Manuscript submitted 11 August 2008. Accepted after revision 7 January 2009.
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