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Electrophysiological Study Prognostic Value and Long-Term Outcome in Drug-Induced Type 1 Brugada Syndrome: The IBRYD

Vincenzo Russo1, Pia Clara Pafundi2, Alfredo Caturano2

  • 1Department of Medical Translational Sciences, Division of Cardiology, Monaldi Hospital, University of Campania "Luigi Vanvitelli," Naples, Italy.

JACC. Clinical Electrophysiology
|May 2, 2021
PubMed

Insights

Drug-induced Brugada syndrome (BrS) patients have a low risk of cardiac events. Electrophysiological study (EPS) and syncope help guide implantable cardioverter-defibrillator (ICD) decisions but do not reliably predict risk.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Genetics

Background:

  • Brugada syndrome (BrS) is an inherited cardiac condition associated with sudden cardiac death.
  • Limited real-world data exist on long-term outcomes for drug-induced type 1 BrS.
  • Risk stratification for these patients remains an area of ongoing investigation.

Purpose of the Study:

  • To retrospectively evaluate long-term outcomes in patients with drug-induced type 1 BrS.
  • To assess the prognostic value of electrophysiological study (EPS) in stratifying risk for these patients.
  • To identify predictors for implantable cardioverter-defibrillator (ICD) implantation and arrhythmia induction during EPS.

Main Methods:

  • The Italian Brugada Syndrome (IBRYD) study enrolled 226 patients with drug-induced type 1 BrS from 9 centers.
  • The primary endpoint was a composite of appropriate ICD therapy and sudden cardiac death.
  • Analysis included clinical predictors, EPS findings, and their association with outcomes.

Main Results:

  • 142 patients (62.8%) received an ICD, primarily due to syncope or inducible ventricular tachyarrhythmias during EPS.
  • Over a median follow-up of 106 months, 11 patients (4.9%) experienced primary outcome events, with a low annual ICD therapy incidence.
  • Ventricular tachyarrhythmia inducibility during EPS showed low positive predictive value but high negative predictive value for arrhythmic events. ICD-related complications and inappropriate shocks occurred in 4.9% of patients.

Conclusions:

  • Drug-induced type 1 BrS is associated with a very low arrhythmic risk.
  • Syncope and EPS positivity inform ICD implantation decisions but do not effectively stratify high-risk patients.
  • A balanced consideration of arrhythmic risk and ICD-related complications is crucial for optimizing patient management.
Abstract

Keywords:
Brugada syndromearrhythmiadrug-induced type 1 Brugada syndromeelectrophysiological studyimplantable cardioverter-defibrillatorsudden cardiac death

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