Brugada syndrome: Eligibility for subcutaneous implantable cardioverter-defibrillator after exercise stress test
Pedro von Hafe1, Bebiana Faria1, Geraldo Dias1
1Cardiology Department, Senhora da Oliveira Hospital, Guimarães, Portugal.
Insights
Exercise stress testing (EST) can affect subcutaneous implantable cardioverter-defibrillator (S-ICD) eligibility in Brugada syndrome (BrS) patients. Screening after EST is crucial, as 16.7% lost eligibility, potentially impacting device choice and treatment strategies.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Brugada syndrome (BrS) is a genetic channelopathy linked to sudden cardiac death.
- Implantable cardioverter-defibrillators (ICDs) are vital for high-risk BrS patients.
- Subcutaneous ICDs (S-ICDs) offer an alternative to transvenous systems, reducing infection risks.
Purpose of the Study:
- To evaluate electrocardiographic eligibility for S-ICD implantation in Brugada syndrome patients following exercise stress testing (EST).
Main Methods:
- Assessed S-ICD eligibility using the Boston Scientific EMBLEM™ automated screening tool in 35 BrS patients.
- Eligibility was checked in four positions: decubitus, orthostatism, before EST, and after EST.
- Patients with at least one acceptable vector across all measurements were deemed eligible.
Main Results:
- Prior to EST, 14.3% of patients were ineligible for S-ICD.
- Ineligibility correlated with complete right bundle branch block and syncope history.
- Post-EST, 16.7% of previously eligible patients lost their acceptable S-ICD vectors.
Conclusions:
- Exercise stress testing significantly impacts S-ICD eligibility in Brugada syndrome patients.
- Post-EST screening is essential for accurate S-ICD candidacy assessment.
- Findings may guide decisions on ICD type and pharmacological interventions to prevent inappropriate shocks.
Introduction:
Brugada syndrome (BrS) is a channelopathy associated with ventricular arrhythmias and sudden cardiac death. In patients at high risk of sudden death, an implantable cardioverter-defibrillator is indicated. Subcutaneous implantable cardioverter-defibrillators (S-ICDs) are an alternative to transvenous systems, with reduced risk of infection and complications associated with system extraction or explantation.
Objective:
To test electrocardiographic eligibility for S-ICD placement after exercise stress testing (EST) in patients with BrS.
Methods:
The sample included 35 consecutive patients with BrS. Electrocardiographic eligibility was assessed using the Boston Scientific model 2889 EMBLEM™ S-ICD automated screening tool, in four phases: decubitus and orthostatism, and before and after EST. Those who had at least one acceptable vector in the four measurements were considered eligible.
Results:
In this study, 71.4% of patients were male and mean age was 53.86±12 years. In screening prior to EST, 14.3% of patients (n=5) were not eligible for an S-ICD. There was a statistically significant association between ineligibility and presence of complete right bundle branch block and history of syncope. After EST, 16.7% of initially eligible patients no longer had eligible vectors (n=5).
Conclusion:
In this study, 16.7% of patients previously eligible for an S-ICD were no longer eligible after EST. This result demonstrates the importance of screening after EST in all patients with BrS and with indication for an S-ICD, and may influence decisions concerning which ICD to implant or whether to institute pharmacological measures that avoid inappropriate therapies.
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