Retrospective Analysis of Patients with Brugada Syndrome and Implantable Cardioverter Defibrillator

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Abstract

Introduction
The Brugada syndrome is an inherited, electrical anomaly, with increased risk of sudden cardiac death. Automatic cardioverter
defibrillators are the only effective treatment to prevent sudden cardiac death, while therapy management in asymptomatic patients is still controversial.
Objectives
The aims of the study were to evaluate the incidence and causes of appropriate and inappropriate shocks and the complications related to the device, and to identify the relation of clinical and electrophysiological study variables with the
incidence of appropriate shocks.
Methods
This was a single-center, retrospective registry of patients with Brugada syndrome, with type-1 electrocardiographic pattern, either spontaneous or induced by ajmaline infusion, defibrillator.
Results
Twenty-one patients were included in the study; 18 were males, and average age was 40 years. The device was indicated due to the following symptoms: nocturnal agonal respiration, syncope and aborted cardiac arrest, or positive electrophysiology study in asymptomatic patients. There were no deaths during follow-up of 88 months, and the yearly rate of appropriate shocks was 1.9%, below that of inappropriate shocks (7.5%). Ten patients presented complications including device infection and psychiatric disorders.  The only variable significantly related with the presence of appropriate shocks was history of fibrillation and atrial flutter.
Conclusions
A low yearly rate of appropriate shocks was observed. The difficulties in risk stratification, the high incidence of inappropriate shocks and the high frequency of complications indicate need of careful patient selection for the implantation of these devices until more reliable predictors of arrhythmic risk are found.