Risk stratification in individuals with the Brugada type 1 ECG pattern without previous cardiac arrest: usefulness of
Pietro Delise1, Giuseppe Allocca, Elena Marras
1Department of Cardiology, General Hospital of Conegliano, Via Brigata Bisagno 4, Conegliano, Treviso, Italy. alloccag75@libero.it
European Heart Journal
|October 28, 2010
Summary
Identifying individuals with Brugada type 1 ECG at high risk for sudden death requires a multiparametric approach. A spontaneous type 1 ECG combined with at least two risk factors, such as syncope or a positive electrophysiologic study, indicates the highest risk group.
Area of Science:
- Cardiology
- Electrophysiology
- Preventive Medicine
Background:
- Brugada electrocardiogram (ECG) pattern type 1 is associated with an increased risk of sudden death (SD).
- Accurate risk stratification is crucial for primary prevention of SD in these individuals.
Purpose of the Study:
- To identify clinical risk factors and electrophysiologic study (EPS) findings that predict major arrhythmic events (MAE) in patients with Brugada type 1 ECG.
- To develop a risk stratification strategy for primary prevention of SD.
Main Methods:
- Retrospective analysis of 320 patients with type 1 Brugada ECG.
- Assessment of spontaneous vs. drug-induced type 1 ECG, syncope, family history of SD, and EPS results.
- Follow-up for MAE, including resuscitated ventricular fibrillation and SD.
Main Results:
- A spontaneous type 1 ECG and syncope were significant risk factors for MAE.
- Positive EPS was associated with a higher event rate.
- All MAE occurred in patients with at least two risk factors (syncope, family history of SD, positive EPS).
- Patients with spontaneous type 1 ECG and at least two risk factors had a 30% event rate.
Conclusions:
- No single risk factor or EPS alone can identify individuals at highest risk.
- A multiparametric approach combining clinical factors and EPS is necessary for accurate risk stratification.
- Patients with spontaneous type 1 ECG and multiple risk factors represent the highest-risk group for sudden death.
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