Meta-Analysis of Clinical Outcome After Implantable Cardioverter-Defibrillator Implantation in Patients With Brugada Syndrome

OBJECTIVES This study sought to summarize the clinical outcome of implantable cardioverter-defibrillator (ICD) therapy in patients with Brugada syndrome. BACKGROUND Brugada syndrome is characterized by cardiac conduction abnormalities and a high risk of ventricular arrhythmias that may result in sudden cardiac death. A complete overview of clinical outcome, appropriate and inappropriate interventions, and complications after ICD therapy in patients with Brugada syndrome is lacking. METHODS The online MEDLINE database was searched for published reports and yielded 828 studies on outcome and complications after ICD therapy in patients with Brugada syndrome. After careful evaluation, 22 studies including a total of 1,539 patients were included in the meta-analysis. RESULTS In total, 1,539 patients (mean age 45 years, 18% women) underwent ICD implantation for primary (79%) or secondary (21%) prevention of sudden cardiac death. During a mean follow-up of 4.9 years, the appropriate and inappropriate ICD intervention rates were 3.1 and 3.3 per 100 person-years, respectively. The cardiac mortality rate was 0.03 per 100 person-years and noncardiac mortality rate was 0.3 per 100 person-years. ICD-related complications per 100 person-years consisted of lead malfunction (1.6), psychological complication (1.3), infection (0.6), lead dislocation (0.4), and any complication (0.6). CONCLUSIONS Patients with Brugada syndrome judged to be at high risk for ventricular arrhythmia may significantly benefit from ICD therapy, which is associated with an appropriate ICD intervention rate of 3.1 per 100 person-years and low cardiac and noncardiac mortality rates. Inappropriate ICD interventions and ICD-related complications may lead to considerable morbidity. (C) 2019 by the American College of Cardiology Foundation.