Long-Term Follow-Up of Probands With Brugada Syndrome

Carlo de Asmundis, Giacomo Mugnai, Gian-Battista Chierchia, Juan Sieira, Giulio Conte, Moises Rodriguez-Mañero, Gudrun Pappaert, Jens Czapla, Jan Nijs, Mark La Meir, Ruben Casado, Erwin Ströker, Valentina De Regibus, Pedro Brugada

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

This study analyzes the natural history of a large cohort of probands with Brugada syndrome (BrS) to assess the predictive value of different clinical and electrocardiographic parameters for the development of ventricular fibrillation (VF) or sudden cardiac death (SCD) during a long-term follow-up. Baseline characteristics of 289 consecutive probands (203 men; mean age 45 ± 16 years) with a Brugada type 1 electrocardiogram were analyzed. After a mean follow-up of 10.1 ± 4.6 years, 29 malignant arrhythmias occurred. On multivariate analysis, a history of VF and syncopal episodes, fragmented QRS (f-QRS), spontaneous type 1 electrocardiogram, and early repolarization pattern were significantly associated with later occurrence of VF/SCD. In patients with drug-induced BrS, the accentuation or de novo appearance of f-QRS in other leads was always associated with VF/SCD. Cerebrovascular events occurred in 8 patients with atrial fibrillation (15.1%), most of them (75%) presenting as the first clinical manifestation. The time-to-diagnosis was found to be significantly shorter in those patients who directly came to our center than in those who referred to our center for a second opinion. In conclusion, systematic use of the pharmacologic challenge in patients with unexplained cardiovascular symptoms and/or atrial fibrillation might significantly improve the identification of BrS with a shortening of the time-to-diagnosis. The CHA2DS2VASc score might be inappropriate for predicting transient ischemic attack or stroke in BrS. This study confirms the independent predictive value of previous VF and syncopal episodes, f-QRS, type 1 electrocardiogram, and early repolarization pattern. In BrS a sufficiently long follow-up is necessary before conclusions on prognosis are apparent.

Original languageEnglish
Pages (from-to)1392-1400
Number of pages9
JournalThe American Journal of Cardiology
Volume119
Issue number9
DOIs
Publication statusPublished - 1 May 2017

Keywords

  • Brugada Syndrome
  • ventricular fibrillation
  • Sudden Cardiac Death
  • Multivariate Analysis
  • Prospective Studies
  • Follow-Up Studies
  • Risk Assessment
  • Humans
  • Middle Aged
  • Atrial Fibrillation/epidemiology
  • Death, Sudden, Cardiac/epidemiology
  • Male
  • Brugada Syndrome/diagnosis
  • Delayed Diagnosis
  • Belgium/epidemiology
  • Defibrillators, Implantable
  • Electrocardiography
  • Adult
  • Female
  • Stroke/epidemiology
  • Aged
  • Ventricular Fibrillation/epidemiology
  • Longitudinal Studies

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