Drug-induced brugada syndrome in children: Clinical features, device-based management and long-term follow-up

Introduction: Specific data on the clinical characteristics and prognosis of drug-induced BS in patients younger than 16 years are lacking. The purpose of this study was to investigate the clinical features, the management and the long-term follow-up of children with drug-induced BS. Methods: Among 401 patients with ajmaline-induced BS, individual younger than 16 years at the time of diagnosis were considered as children and eligible for this study. Results: There were 40 children (60% male, mean age: 10±3.8 years) identified. A family history of SD was present in 24 individuals (60%). Two children (5%) had a previous episode of aborted sudden death and 8 (20%) had suffered from syncope. Children presented more frequently with signs of sinus node dysfunction as compared to individuals older than 16 years (7.5% vs 1.5%, p=0.04) and had a comparable incidence of previous history of atrial fibrillation. Twelve children (30%) underwent implantable cardioverter defibrillator (ICD) implantation. After a mean follow-up time of 50±21 months, none of the children died suddenly. Spontaneous sustained ventricular arrhythmias were documented in 1 child (2%). Among children with ICD, 1 (8%) experienced an appropriate shock, 4 (33%) had inappropriate ICD shocks and 4 (33%) experienced devicerelated complications. Conclusions: Similarly to adult patients, drug-induced BS in children is commonly associated with sustained atrial arrhythmias and sinus node dysfunction. In children with ICD, the rate of device-related problems, which can lead to electrode replacement or inappropriate shocks, is considerable.