Implantable loop recorders in patients with Brugada syndrome: the BruLoop study

Marco Bergonti; Frederic Sacher; Elena Arbelo; Lia Crotti; Avi Sabbag; Michela Casella; Johan Saenen; Andrea Rossi; Cinzia Monaco; Luigi Pannone; Paolo Compagnucci; Vincenzo Russo; Eyal Heller; Amato Santoro; Paola Berne; Antonio Bisignani; Enrico Baldi; Olivier Van Leuven; Federico Migliore; Lorenzo Marcon; Federica Dagradi; Irene Sfondrini; Federico Landra; Angelo Comune; María Cespón-Fernández; Martina Nesti; Francesco Santoro; Michele Magnocavallo; Alessandro Vicentini; Sergio Conti; Valentina Ribatti; Pedro Brugada; Carlo de Asmundis; Josep Brugada; Claudio Tondo; Peter J Schwartz; Michel Haissaguerre; Angelo Auricchio; Giulio Conte

doi:10.1093/eurheartj/ehae133

Implantable loop recorders in patients with Brugada syndrome: the BruLoop study

Marco Bergonti, Frederic Sacher, Elena Arbelo, Lia Crotti, Avi Sabbag, Michela Casella, Johan Saenen, Andrea Rossi, Cinzia Monaco, Luigi Pannone, Paolo Compagnucci, Vincenzo Russo, Eyal Heller, Amato Santoro, Paola Berne, Antonio Bisignani, Enrico Baldi, Olivier Van Leuven, Federico Migliore, Lorenzo MarconFederica Dagradi, Irene Sfondrini, Federico Landra, Angelo Comune, María Cespón-Fernández, Martina Nesti, Francesco Santoro, Michele Magnocavallo, Alessandro Vicentini, Sergio Conti, Valentina Ribatti, Pedro Brugada, Carlo de Asmundis, Josep Brugada, Claudio Tondo, Peter J Schwartz, Michel Haissaguerre, Angelo Auricchio, Giulio Conte

Research output: Contribution to journal › Article › peer-review

8 Citations (Scopus)

Abstract

BACKGROUND AND AIMS: Available data on continuous rhythm monitoring by implantable loop recorders (ILRs) in patients with Brugada syndrome (BrS) are scarce. The aim of this multi-centre study was to evaluate the diagnostic yield and clinical implication of a continuous rhythm monitoring strategy by ILRs in a large cohort of BrS patients and to assess the precise arrhythmic cause of syncopal episodes.

METHODS: A total of 370 patients with BrS and ILRs (mean age 43.5 ± 15.9, 33.8% female, 74.1% symptomatic) from 18 international centers were included. Patients were followed with continuous rhythm monitoring for a median follow-up of 3 years.

RESULTS: During follow-up, an arrhythmic event was recorded in 30.7% of symptomatic patients [18.6% atrial arrhythmias (AAs), 10.2% bradyarrhythmias (BAs), and 7.3% ventricular arrhythmias (VAs)]. In patients with recurrent syncope, the aetiology was arrhythmic in 22.4% (59.3% BAs, 25.0% VAs, and 15.6% AAs). The ILR led to drug therapy initiation in 11.4%, ablation procedure in 10.9%, implantation of a pacemaker in 2.5%, and a cardioverter-defibrillator in 8%. At multivariate analysis, the presence of symptoms [hazard ratio (HR) 2.5, P = .001] and age >50 years (HR 1.7, P = .016) were independent predictors of arrhythmic events, while inducibility of ventricular fibrillation at the electrophysiological study (HR 9.0, P < .001) was a predictor of VAs.

CONCLUSIONS: ILR detects arrhythmic events in nearly 30% of symptomatic BrS patients, leading to appropriate therapy in 70% of them. The most commonly detected arrhythmias are AAs and BAs, while VAs are detected only in 7% of cases. Symptom status can be used to guide ILR implantation.

Original language	English
Pages (from-to)	1255-1265
Number of pages	11
Journal	European Heart Journal
Volume	45
Issue number	14
DOIs	https://doi.org/10.1093/eurheartj/ehae133 https://doi.org/10.1093/EURHEARTJ/EHAE133
Publication status	Published - 7 Apr 2024

Bibliographical note

Keywords

Female
Humans
Male
Middle Aged
Arrhythmias, Cardiac/complications
Brugada Syndrome/complications
Defibrillators, Implantable
Electrocardiography/methods
Electrocardiography, Ambulatory/methods
Pacemaker, Artificial
Adult

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Bergonti, M., Sacher, F., Arbelo, E., Crotti, L., Sabbag, A., Casella, M., Saenen, J., Rossi, A., Monaco, C., Pannone, L., Compagnucci, P., Russo, V., Heller, E., Santoro, A., Berne, P., Bisignani, A., Baldi, E., Van Leuven, O., Migliore, F., ... Conte, G. (2024). Implantable loop recorders in patients with Brugada syndrome: the BruLoop study. European Heart Journal, 45(14), 1255-1265. https://doi.org/10.1093/eurheartj/ehae133, https://doi.org/10.1093/EURHEARTJ/EHAE133

Bergonti, Marco ; Sacher, Frederic ; Arbelo, Elena ; Crotti, Lia ; Sabbag, Avi ; Casella, Michela ; Saenen, Johan ; Rossi, Andrea ; Monaco, Cinzia ; Pannone, Luigi ; Compagnucci, Paolo ; Russo, Vincenzo ; Heller, Eyal ; Santoro, Amato ; Berne, Paola ; Bisignani, Antonio ; Baldi, Enrico ; Van Leuven, Olivier ; Migliore, Federico ; Marcon, Lorenzo ; Dagradi, Federica ; Sfondrini, Irene ; Landra, Federico ; Comune, Angelo ; Cespón-Fernández, María ; Nesti, Martina ; Santoro, Francesco ; Magnocavallo, Michele ; Vicentini, Alessandro ; Conti, Sergio ; Ribatti, Valentina ; Brugada, Pedro ; de Asmundis, Carlo ; Brugada, Josep ; Tondo, Claudio ; Schwartz, Peter J ; Haissaguerre, Michel ; Auricchio, Angelo ; Conte, Giulio. / Implantable loop recorders in patients with Brugada syndrome : the BruLoop study. In: European Heart Journal. 2024 ; Vol. 45, No. 14. pp. 1255-1265.

@article{d4a763d97def403285cc77706360c994,

title = "Implantable loop recorders in patients with Brugada syndrome: the BruLoop study",

abstract = "BACKGROUND AND AIMS: Available data on continuous rhythm monitoring by implantable loop recorders (ILRs) in patients with Brugada syndrome (BrS) are scarce. The aim of this multi-centre study was to evaluate the diagnostic yield and clinical implication of a continuous rhythm monitoring strategy by ILRs in a large cohort of BrS patients and to assess the precise arrhythmic cause of syncopal episodes.METHODS: A total of 370 patients with BrS and ILRs (mean age 43.5 ± 15.9, 33.8% female, 74.1% symptomatic) from 18 international centers were included. Patients were followed with continuous rhythm monitoring for a median follow-up of 3 years.RESULTS: During follow-up, an arrhythmic event was recorded in 30.7% of symptomatic patients [18.6% atrial arrhythmias (AAs), 10.2% bradyarrhythmias (BAs), and 7.3% ventricular arrhythmias (VAs)]. In patients with recurrent syncope, the aetiology was arrhythmic in 22.4% (59.3% BAs, 25.0% VAs, and 15.6% AAs). The ILR led to drug therapy initiation in 11.4%, ablation procedure in 10.9%, implantation of a pacemaker in 2.5%, and a cardioverter-defibrillator in 8%. At multivariate analysis, the presence of symptoms [hazard ratio (HR) 2.5, P = .001] and age >50 years (HR 1.7, P = .016) were independent predictors of arrhythmic events, while inducibility of ventricular fibrillation at the electrophysiological study (HR 9.0, P < .001) was a predictor of VAs.CONCLUSIONS: ILR detects arrhythmic events in nearly 30% of symptomatic BrS patients, leading to appropriate therapy in 70% of them. The most commonly detected arrhythmias are AAs and BAs, while VAs are detected only in 7% of cases. Symptom status can be used to guide ILR implantation.",

keywords = "Female, Humans, Male, Middle Aged, Arrhythmias, Cardiac/complications, Brugada Syndrome/complications, Defibrillators, Implantable, Electrocardiography/methods, Electrocardiography, Ambulatory/methods, Pacemaker, Artificial, Adult",

author = "Marco Bergonti and Frederic Sacher and Elena Arbelo and Lia Crotti and Avi Sabbag and Michela Casella and Johan Saenen and Andrea Rossi and Cinzia Monaco and Luigi Pannone and Paolo Compagnucci and Vincenzo Russo and Eyal Heller and Amato Santoro and Paola Berne and Antonio Bisignani and Enrico Baldi and {Van Leuven}, Olivier and Federico Migliore and Lorenzo Marcon and Federica Dagradi and Irene Sfondrini and Federico Landra and Angelo Comune and Mar{\'i}a Cesp{\'o}n-Fern{\'a}ndez and Martina Nesti and Francesco Santoro and Michele Magnocavallo and Alessandro Vicentini and Sergio Conti and Valentina Ribatti and Pedro Brugada and {de Asmundis}, Carlo and Josep Brugada and Claudio Tondo and Schwartz, {Peter J} and Michel Haissaguerre and Angelo Auricchio and Giulio Conte",

note = "{\textcopyright} The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.",

year = "2024",

month = apr,

day = "7",

doi = "10.1093/eurheartj/ehae133",

language = "English",

volume = "45",

pages = "1255--1265",

journal = "European Heart Journal",

issn = "0195-668X",

publisher = "Oxford University Press",

number = "14",

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Bergonti, M, Sacher, F, Arbelo, E, Crotti, L, Sabbag, A, Casella, M, Saenen, J, Rossi, A, Monaco, C , Pannone, L, Compagnucci, P, Russo, V, Heller, E, Santoro, A, Berne, P, Bisignani, A, Baldi, E, Van Leuven, O, Migliore, F, Marcon, L, Dagradi, F, Sfondrini, I, Landra, F, Comune, A, Cespón-Fernández, M, Nesti, M, Santoro, F, Magnocavallo, M, Vicentini, A, Conti, S, Ribatti, V, Brugada, P , de Asmundis, C, Brugada, J, Tondo, C, Schwartz, PJ, Haissaguerre, M, Auricchio, A & Conte, G 2024, 'Implantable loop recorders in patients with Brugada syndrome: the BruLoop study', European Heart Journal, vol. 45, no. 14, pp. 1255-1265. https://doi.org/10.1093/eurheartj/ehae133, https://doi.org/10.1093/EURHEARTJ/EHAE133

Implantable loop recorders in patients with Brugada syndrome : the BruLoop study. / Bergonti, Marco; Sacher, Frederic; Arbelo, Elena; Crotti, Lia; Sabbag, Avi; Casella, Michela; Saenen, Johan; Rossi, Andrea; Monaco, Cinzia ; Pannone, Luigi; Compagnucci, Paolo; Russo, Vincenzo; Heller, Eyal; Santoro, Amato; Berne, Paola; Bisignani, Antonio; Baldi, Enrico; Van Leuven, Olivier; Migliore, Federico; Marcon, Lorenzo; Dagradi, Federica; Sfondrini, Irene; Landra, Federico; Comune, Angelo; Cespón-Fernández, María; Nesti, Martina; Santoro, Francesco; Magnocavallo, Michele; Vicentini, Alessandro; Conti, Sergio; Ribatti, Valentina; Brugada, Pedro ; de Asmundis, Carlo; Brugada, Josep; Tondo, Claudio; Schwartz, Peter J; Haissaguerre, Michel; Auricchio, Angelo; Conte, Giulio.

In: European Heart Journal, Vol. 45, No. 14, 07.04.2024, p. 1255-1265.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Implantable loop recorders in patients with Brugada syndrome

T2 - the BruLoop study

AU - Bergonti, Marco

AU - Sacher, Frederic

AU - Arbelo, Elena

AU - Crotti, Lia

AU - Sabbag, Avi

AU - Casella, Michela

AU - Saenen, Johan

AU - Rossi, Andrea

AU - Monaco, Cinzia

AU - Pannone, Luigi

AU - Compagnucci, Paolo

AU - Russo, Vincenzo

AU - Heller, Eyal

AU - Santoro, Amato

AU - Berne, Paola

AU - Bisignani, Antonio

AU - Baldi, Enrico

AU - Van Leuven, Olivier

AU - Migliore, Federico

AU - Marcon, Lorenzo

AU - Dagradi, Federica

AU - Sfondrini, Irene

AU - Landra, Federico

AU - Comune, Angelo

AU - Cespón-Fernández, María

AU - Nesti, Martina

AU - Santoro, Francesco

AU - Magnocavallo, Michele

AU - Vicentini, Alessandro

AU - Conti, Sergio

AU - Ribatti, Valentina

AU - Brugada, Pedro

AU - de Asmundis, Carlo

AU - Brugada, Josep

AU - Tondo, Claudio

AU - Schwartz, Peter J

AU - Haissaguerre, Michel

AU - Auricchio, Angelo

AU - Conte, Giulio

PY - 2024/4/7

Y1 - 2024/4/7

N2 - BACKGROUND AND AIMS: Available data on continuous rhythm monitoring by implantable loop recorders (ILRs) in patients with Brugada syndrome (BrS) are scarce. The aim of this multi-centre study was to evaluate the diagnostic yield and clinical implication of a continuous rhythm monitoring strategy by ILRs in a large cohort of BrS patients and to assess the precise arrhythmic cause of syncopal episodes.METHODS: A total of 370 patients with BrS and ILRs (mean age 43.5 ± 15.9, 33.8% female, 74.1% symptomatic) from 18 international centers were included. Patients were followed with continuous rhythm monitoring for a median follow-up of 3 years.RESULTS: During follow-up, an arrhythmic event was recorded in 30.7% of symptomatic patients [18.6% atrial arrhythmias (AAs), 10.2% bradyarrhythmias (BAs), and 7.3% ventricular arrhythmias (VAs)]. In patients with recurrent syncope, the aetiology was arrhythmic in 22.4% (59.3% BAs, 25.0% VAs, and 15.6% AAs). The ILR led to drug therapy initiation in 11.4%, ablation procedure in 10.9%, implantation of a pacemaker in 2.5%, and a cardioverter-defibrillator in 8%. At multivariate analysis, the presence of symptoms [hazard ratio (HR) 2.5, P = .001] and age >50 years (HR 1.7, P = .016) were independent predictors of arrhythmic events, while inducibility of ventricular fibrillation at the electrophysiological study (HR 9.0, P < .001) was a predictor of VAs.CONCLUSIONS: ILR detects arrhythmic events in nearly 30% of symptomatic BrS patients, leading to appropriate therapy in 70% of them. The most commonly detected arrhythmias are AAs and BAs, while VAs are detected only in 7% of cases. Symptom status can be used to guide ILR implantation.

AB - BACKGROUND AND AIMS: Available data on continuous rhythm monitoring by implantable loop recorders (ILRs) in patients with Brugada syndrome (BrS) are scarce. The aim of this multi-centre study was to evaluate the diagnostic yield and clinical implication of a continuous rhythm monitoring strategy by ILRs in a large cohort of BrS patients and to assess the precise arrhythmic cause of syncopal episodes.METHODS: A total of 370 patients with BrS and ILRs (mean age 43.5 ± 15.9, 33.8% female, 74.1% symptomatic) from 18 international centers were included. Patients were followed with continuous rhythm monitoring for a median follow-up of 3 years.RESULTS: During follow-up, an arrhythmic event was recorded in 30.7% of symptomatic patients [18.6% atrial arrhythmias (AAs), 10.2% bradyarrhythmias (BAs), and 7.3% ventricular arrhythmias (VAs)]. In patients with recurrent syncope, the aetiology was arrhythmic in 22.4% (59.3% BAs, 25.0% VAs, and 15.6% AAs). The ILR led to drug therapy initiation in 11.4%, ablation procedure in 10.9%, implantation of a pacemaker in 2.5%, and a cardioverter-defibrillator in 8%. At multivariate analysis, the presence of symptoms [hazard ratio (HR) 2.5, P = .001] and age >50 years (HR 1.7, P = .016) were independent predictors of arrhythmic events, while inducibility of ventricular fibrillation at the electrophysiological study (HR 9.0, P < .001) was a predictor of VAs.CONCLUSIONS: ILR detects arrhythmic events in nearly 30% of symptomatic BrS patients, leading to appropriate therapy in 70% of them. The most commonly detected arrhythmias are AAs and BAs, while VAs are detected only in 7% of cases. Symptom status can be used to guide ILR implantation.

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Arrhythmias, Cardiac/complications

KW - Brugada Syndrome/complications

KW - Defibrillators, Implantable

KW - Electrocardiography/methods

KW - Electrocardiography, Ambulatory/methods

KW - Pacemaker, Artificial

KW - Adult

UR - http://www.scopus.com/inward/record.url?scp=85189774649&partnerID=8YFLogxK

U2 - 10.1093/eurheartj/ehae133

DO - 10.1093/eurheartj/ehae133

M3 - Article

C2 - 38445836

VL - 45

SP - 1255

EP - 1265

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 14

ER -

Implantable loop recorders in patients with Brugada syndrome: the BruLoop study

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