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Published on: February 28, 2012
Predictors of late arrhythmic events after generator replacement in Brugada syndrome treated with prophylactic ICD
Federico Migliore1, Nicolò Martini1, Leonardo Calo'2
1Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy.
Insights
Brugada syndrome patients with prophylactic ICDs may experience late arrhythmic events. An S-wave in lead I is the sole independent predictor of this persistent risk, highlighting the need for generator replacement.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Brugada syndrome (BrS) patients receiving prophylactic implantable cardioverter defibrillators (ICDs) require evaluation for late life-threatening arrhythmic events.
- Predictors of these late events, especially after generator replacement (GR), are not well-defined.
Purpose of the Study:
- To assess the incidence of late life-threatening arrhythmic events in BrS patients with prophylactic ICDs undergoing GR.
- To identify clinical and electrocardiographic predictors of these late events.
Main Methods:
- A long-term, multicenter study included 105 BrS patients who received a prophylactic ICD and had no arrhythmic events before their first GR.
- Follow-up included assessment of events after GR, with survival analysis and Cox-regression used to identify predictors.
Main Results:
- 9% of patients experienced appropriate ICD intervention (1.6%/year) after GR, primarily shocks for ventricular fibrillation.
- History of atrial fibrillation, conduction disturbances, S-wave in lead I, and first-degree atrioventricular block were associated with late events.
- An S-wave in lead I was the only independent predictor of late appropriate ICD intervention (HR: 9.17).
Conclusions:
- BrS patients with prophylactic ICDs can experience significant late appropriate interventions after generator replacement.
- An S-wave in lead I is a key independent predictor of persistent risk for life-threatening arrhythmias.
- These findings underscore the importance of generator replacement, particularly in BrS patients with conduction abnormalities.
Introduction:
Predictors of late life-threatening arrhythmic events in Brugada syndrome (BrS) patients who received a prophylactic ICD implantation remain to be evaluated. The aim of the present long-term multicenter study was to assess the incidence and clinical-electrocardiographic predictors of late life-threatening arrhythmic events in BrS patients with a prophylactic implantable cardioverter defibrillator (ICD) and undergoing generator replacement (GR).
Methods:
The study population included 105 patients (75% males; mean age 45 ± 14years) who received a prophylactic ICD and had no arrhythmic event up to first GR.
Results:
The median period from first ICD implantation to last follow-up was 155 (128-181) months and from first ICD Implantation to the GR was 84 (61-102) months. During a median follow-up of 57 (38-102) months after GR, 10 patients (9%) received successful appropriate ICD intervention (1.6%/year). ICD interventions included shock on ventricular fibrillation (n = 8 patients), shock on ventricular tachycardia (n = 1 patient), and antitachycardia pacing on ventricular tachycardia (n = 1 patient). At survival analysis, history of atrial fibrillation (log-rank test; P = 0.02), conduction disturbances (log-rank test; P < 0.01), S wave in lead I (log-rank test; P = 0.01) and first-degree atrioventricular block (log-rank test; P = 0.04) were significantly associated with the occurrence of late appropriate ICD intervention. At Cox-regression multivariate analysis, S-wave in lead I was the only independent predictor of late appropriate ICD intervention (HR: 9.17; 95%CI: 1.15-73.07; P = 0.03).
Conclusions:
The present study indicates that BrS patient receiving a prophylactic ICD may experience late appropriate intervention after GR in a clinically relevant proportion of cases. S-wave in lead I at the time of first clinical evaluation was the only independent predictor of persistent risk of life-threatening arrhythmic events. These findings support the need for GR at the end of service regardless of previous appropriate intervention, mostly in BrS patients with conduction abnormalities.
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