Programmed Ventricular Stimulation for Risk Stratification in the Brugada Syndrome: A Pooled Analysis
Jakub Sroubek1, Vincent Probst1, Andrea Mazzanti1
1From Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (J.S.); Service de Cardiologue du CHU de Nantes, CHU de Nantes, Hôpital Nord, Nantes, France (V.P.); Molecular Cardiology, IRCCS Fondazione Salvatore Maugeri, Pavia, Italy (A.M., C.N., S.G.P.); Dipartimento di Medicina, Molecolare Università di Pavia, Pavia, Italy (S.G.P.); Division of Cardiology, Casa di Cura Pederzoli, Peschiera del Garda, Verona, Italy (P.D.); Arrhythmia Unit, Cardiovascular Surgery and Cardiology Institute, Havana, Cuba (J.C.H.); Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (K.O., I.W.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy (A.Z., D.C.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec City, QC, Canada (J.C., I.N.); Department of Electrophysiology and Pacing, Onassis Cardiac Surgery Center, Athens, Greece (A.K., G.T.); Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y.); Cardiovascular Research Center and Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston (D.J.M., P.T.E., S.A.L.); Heart Centre AMC, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (A.W.); Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia (A.W.); Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France (F.S.); First Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany (M.B.); DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany (M.B.); Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA (P.T.E., S.A.L.); Department of Cardiology, General Hospital of Conegliano, Conegliano, Treviso, Italy (G.A.); and Lankenau I
Programmed ventricular stimulation can identify Brugada syndrome patients at high risk for sudden death. Arrhythmia induction, especially with fewer stimuli, indicates increased risk, but clinical factors remain crucial.
Area of Science:
- Cardiology
- Electrophysiology
- Genetics
Background:
- Brugada syndrome is a genetic disorder associated with increased risk of sudden cardiac death.
- The utility of programmed ventricular stimulation (PVS) in risk stratification for Brugada syndrome remains debated.
Purpose of the Study:
- To systematically evaluate the role of PVS in identifying Brugada syndrome patients at high risk for sudden cardiac events.
- To analyze the association between PVS-induced arrhythmias and subsequent cardiac events.
Main Methods:
- A systematic review and pooled analysis of prospective, observational studies.
- Included 1312 patients with Brugada syndrome without prior cardiac arrest, who underwent PVS.
- Analyzed individual-level data to estimate incidence rates and hazards of cardiac arrest or ICD shock.
Main Results:
- Arrhythmia induction during PVS was associated with a 2.66-fold increased risk of cardiac events.
- Induction with fewer extrastimuli (single or double) conferred the highest risk.
- Annual event rates varied significantly based on syncope history, spontaneous Type 1 ECG, and arrhythmia induction.
Conclusions:
- PVS-induced arrhythmias are a significant predictor of future ventricular arrhythmia risk in Brugada syndrome.
- The number of extrastimuli required for induction correlates with risk, with fewer being more dangerous.
- Clinical risk factors are critical; absence of induction does not guarantee low risk, especially in high-risk patients.
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