Long Term Prognosis of Drug-Induced Brugada Syndrome

Juan Sieira, Giuseppe Ciconte, Giulio Conte, Carlo de Asmundis, Gian-Battista Chierchia, Giannis Baltogiannis, Giacomo Di Giovanni, Yukio Saitoh, Ruben Casado-Arroyo, Justo Juliá, Mark La Meir, Francis Wellens, Kristel Wauters, Gudrun Pappaert, Pedro Brugada

Research output: Contribution to journalArticlepeer-review

20 Citations (Scopus)

Abstract

BACKROUND: Patients with a drug-induced Brugada syndrome (BS) are considered at a lower risk than those with the spontaneous type I pattern. Nevertheless, they can present arrhythmic events.

OBJECTIVE: The purpose of this study was to investigate their clinical characteristics, long-term prognosis and risk factors.

METHODS: A consecutive cohort of 343 drug-induced BS patients was included and compared to 78 with spontaneous type I pattern.

RESULTS: Mean age was 40.7±18.3 years. Sudden cardiac death (SCD) was the clinical presentation in 13 (3.8%), syncope in 86 (25.1%) and 244 (71.1%) were asymptomatic. Drug-induced patients were less frequently men (52.5% vs 80.8%, p<0.01), more frequently asymptomatic (71.1% vs 56.4%, p<0.01) and had less ventricular arrhythmias (VA) induced during electrophysiological study (EPS) (13.2% vs 42.4%, p<0.01). A cardioverter defibrillator (ICD) was implanted in 128 patients (37.3%). During a median follow up of 62.5 months (interquartile range: 28.9 - 115.6), 34 patients presented arrhythmic events. Event rate was 1.1% person-year (vs 2.3% person-year in patients with a spontaneous type I, p<0.01). Presentation as SCD and inducible VA were independent risk factors significantly associated with arrhythmic events (adjusted hazard risk (HR) 22.0 and 3.5). Drug-induced BS was related to a better prognosis only in asymptomatic individuals.

CONCLUSIONS: Drug-induced BS has a good prognosis if asymptomatic, however, SCD is possible. Clinical presentation as SCD and inducible VA during EPS are independent risk factors for arrhythmic events. In asymptomatic patients, proband status and inducible VA can help to identify patients at higher risk, but further evidence is needed.

Original languageEnglish
Pages (from-to)1427-1433
Number of pages7
JournalHeart Rhythm
Volume14
Issue number10
DOIs
Publication statusPublished - Oct 2017

Bibliographical note

Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Keywords

  • Adolescent
  • Adult
  • Aged
  • Ajmaline/administration & dosage
  • Anti-Arrhythmia Agents/administration & dosage
  • Belgium/epidemiology
  • Brugada Syndrome/chemically induced
  • Child
  • Child, Preschool
  • Death, Sudden, Cardiac/epidemiology
  • Defibrillators, Implantable
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • Forecasting
  • Humans
  • Incidence
  • Infant
  • Injections, Intravenous
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Survival Rate/trends
  • Time Factors
  • Young Adult

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