Brugada syndrome and syncope: A systematic review

Area of Science:

• Cardiology
• Electrophysiology
• Genetics

Background:

• Brugada syndrome (BrS) presents diagnostic challenges in differentiating syncope causes.
• Malignant arrhythmias pose a significant risk in BrS patients.

Purpose of the Study:

• To evaluate the predictive value of syncope in identifying subsequent malignant arrhythmias in BrS.
• To stratify risk based on syncope type in the BrS population.

Main Methods:

• Systematic literature review of 9 studies including 1347 patients.
• Stratification of patients into suspected arrhythmic syncope (SAS), undefined syncope (US), and neurally-mediated syncope (NMS).

Main Results:

• Suspected arrhythmic syncope (SAS) patients had a 15.7% rate of malignant arrhythmias over 67 months (2.8 events/100 person-years).
• Undefined syncope (US) patients had a 7% rate over 39 months (2.2 events/100 person-years).
• Neurally-mediated syncope (NMS) patients showed a significantly lower rate of 0.7% over follow-up (0.13 events/100 person-years; p < .0001).

Conclusions:

• Syncope type can stratify arrhythmic event risk in Brugada syndrome.
• Clinical diagnosis of SAS has limited predictive value, necessitating multi-parametric assessment.
• Improved risk stratification may refine candidates for implantable cardioverter-defibrillator therapy.