Implantable Cardioverter-Defibrillator Therapy in Brugada Syndrome A 20-Year Single-Center Experience

被引:135
作者
Conte, Giulio [1 ]
Sieira, Juan [1 ]
Ciconte, Giuseppe [1 ]
de Asmundis, Carlo [1 ]
Chierchia, Gian-Battista [1 ]
Baltogiannis, Giannis [1 ]
Di Giovanni, Giacomo [1 ]
La Meir, Mark [2 ]
Wellens, Francis [2 ]
Czapla, Jens [2 ]
Wauters, Kristel [1 ]
Levinstein, Moises [1 ]
Saitoh, Yukio [1 ]
Irfan, Ghazala [1 ]
Julia, Justo [1 ]
Pappaert, Gudrun [1 ]
Brugada, Pedro [1 ]
机构
[1] UZ Brussel VUB, Heart Rhythm Management Ctr, B-1090 Brussels, Belgium
[2] UZ Brussel VUB, Dept Cardiac Surg, B-1090 Brussels, Belgium
关键词
Brugada syndrome; implantable cardioverter-defibrillator; sudden cardiac death; ventricular; arrhythmias; TERM-FOLLOW-UP; RISK STRATIFICATION; PRIMARY PREVENTION; SUDDEN-DEATH; MANAGEMENT; ARRHYTHMIAS; PROGNOSIS; REGISTRY; HISTORY; ICD;
D O I
10.1016/j.jacc.2014.12.031
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND Patients with Brugada syndrome and aborted sudden cardiac death or syncope have higher risks for ventricular arrhythmias (VAs) and should undergo implantable cardioverter-defibrillator (ICD) placement. Device-based management of asymptomatic patients is controversial. ICD therapy is associated with high rates of inappropriate shocks and device-related complications. OBJECTIVES The objective of this study was to investigate clinical features, management, and long-term follow-up of ICD therapy in patients with Brugada syndrome. METHODS Patients presenting with spontaneous or drug-induced Brugada type 1 electrocardiographic findings, who underwent ICD implantation and continuous follow-up at a single institution, were eligible for this study. RESULTS A total of 176 consecutive patients were included. During a mean follow-up period of 83.8 +/- 57.3 months, spontaneous sustained VAs occurred in 30 patients (17%). Eight patients (4.5%) died. Appropriate ICD shocks occurred in 28 patients (15.9%), and 33 patients (18.7%) had inappropriate shocks. Electrical storm occurred in 4 subjects (2.3%). Twenty-eight patients (15.9%) experienced device-related complications. In multivariate Cox regression analysis, aborted sudden cardiac death and VA inducibility on electrophysiologic studies were independent predictors of appropriate shock occurrence. CONCLUSIONS ICD therapy was an effective strategy in Brugada syndrome, treating potentially lethal arrhythmias in 17% of patients during long-term follow-up. Appropriate shocks were significantly associated with the presence of aborted sudden cardiac death but also occurred in 13% of asymptomatic patients. Risk stratification by electrophysiologic study may identify asymptomatic patients at risk for arrhythmic events and could be helpful in investigating syncope not related to VAs. ICD placement is frequently associated with device-related complications, and rates of inappropriate shocks remain high regardless of careful device programming. (C) 2015 by the American College of Cardiology Foundation.
引用
收藏
页码:879 / 888
页数:10
相关论文
共 22 条
[1]   Brugada syndrome - Report of the second consensus conference - Endorsed by the Heart Rhythm Society and the European Heart Rhythm Association [J].
Antzelevitch, C ;
Brugada, P ;
Borggrefe, M ;
Brugada, J ;
Brugada, R ;
Corrado, D ;
Gussak, I ;
LeMarec, H ;
Nademanee, K ;
Riera, ARP ;
Shimizu, W ;
Schulze-Bahr, E ;
Tan, H ;
Wilde, A .
CIRCULATION, 2005, 111 (05) :659-670
[2]   Incidence, clinical implications and prognosis of atrial arrhythmias in Brugada syndrome [J].
Bordachar, P ;
Reuter, S ;
Garrigue, S ;
Caï, X ;
Hocini, M ;
Jaïs, P ;
Haïssaguerre, M ;
Clementy, J .
EUROPEAN HEART JOURNAL, 2004, 25 (10) :879-884
[3]   Pharmacological and device approach to therapy of inherited cardiac diseases associated with cardiac arrhythmias and sudden death [J].
Brugada, J ;
Brugada, R ;
Brugada, P .
JOURNAL OF ELECTROCARDIOLOGY, 2000, 33 :41-47
[4]   RIGHT BUNDLE-BRANCH BLOCK, PERSISTENT ST SEGMENT ELEVATION AND SUDDEN CARDIAC DEATH - A DISTINCT CLINICAL AND ELECTROCARDIOGRAPHIC SYNDROME - A MULTICENTER REPORT [J].
BRUGADA, P ;
BRUGADA, J .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1992, 20 (06) :1391-1396
[5]   Drug-Induced Brugada Syndrome in Children Clinical Features, Device-Based Management, and Long-Term Follow-Up [J].
Conte, Giulio ;
Dewals, Wendy ;
Sieira, Juan ;
de Asmundis, Carlo ;
Ciconte, Giuseppe ;
Chierchia, Gian-Battista ;
Di Giovanni, Giacomo ;
Baltogiannis, Giannis ;
Saitoh, Yukio ;
Levinstein, Moises ;
La Meir, Mark ;
Wellens, Francis ;
Pappaert, Gudrun ;
Brugada, Pedro .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2014, 63 (21) :2272-2279
[6]   Effect of Long-Detection Interval vs Standard-Detection Interval for Implantable Cardioverter-Defibrillators on Antitachycardia Pacing and Shock Delivery The ADVANCE III Randomized Clinical Trial [J].
Gasparini, Maurizio ;
Proclemer, Alessandro ;
Klersy, Catherine ;
Kloppe, Axel ;
Lunati, Maurizio ;
Martinez Ferrer, Jose Bautista ;
Hersi, Ahmad ;
Gulaj, Marcin ;
Wijfels, Maurits C. E. F. ;
Santi, Elisabetta ;
Manotta, Laura ;
Arenal, Angel .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2013, 309 (18) :1903-1911
[7]   A simplified biventricular defibrillator with fixed long detection intervals reduces implantable cardioverter defibrillator (ICD) interventions and heart failure hospitalizations in patients with non-ischaemic cardiomyopathy implanted for primary prevention: the RELEVANT [Role of long dEtection window programming in patients with LEft VentriculAr dysfunction, Non-ischemic eTiology in primary prevention treated with a biventricular ICD] study [J].
Gasparini, Maurizio ;
Menozzi, Carlo ;
Proclemer, Alessandro ;
Landolina, Maurizio ;
Iacopino, Severio ;
Carboni, Angelo ;
Lombardo, Ernesto ;
Regoli, Francois ;
Biffi, Mauro ;
Burrone, Valeria ;
Denaro, Alessandra ;
Boriani, Giuseppe .
EUROPEAN HEART JOURNAL, 2009, 30 (22) :2758-2767
[8]   Hydroquinidine therapy in Brugada syndrome [J].
Hermida, JS ;
Denjoy, I ;
Clerc, J ;
Extramiana, F ;
Jarry, G ;
Milliez, P ;
Guicheney, P ;
Di Fusco, S ;
Rey, JL ;
Cauchemez, B ;
Leenhardt, A .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2004, 43 (10) :1853-1860
[9]   Annual rate of transvenous defibrillation lead defects in implantable cardioverter-defibrillators over a period of > 10 years [J].
Kleemann, Thomas ;
Becker, Torsten ;
Doenges, Klaus ;
Vater, Margit ;
Senges, Jochen ;
Schneider, Steffen ;
Saggau, Werner ;
Weisse, Udo ;
Seidl, Karlheinz .
CIRCULATION, 2007, 115 (19) :2474-2480
[10]   Atrial fibrillation and atrial vulnerability in patients with Brugada syndrome [J].
Morita, H ;
Kusano-Fukushima, K ;
Nagase, S ;
Fujimoto, Y ;
Hisamatsu, K ;
Fujio, H ;
Haraoka, K ;
Kobayashi, M ;
Morita, ST ;
Nakamura, K ;
Emori, T ;
Matsubara, H ;
Hina, K ;
Kita, T ;
Fukatani, M ;
Ohe, T .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 40 (08) :1437-1444