Asymptomatic Patients With Brugada ECG Pattern: Long-Term Prognosis From a Large Prospective Study

Area of Science:

• Cardiology
• Clinical Electrophysiology
• Genetic Cardiology

Background:

• Brugada syndrome presents management challenges, especially for asymptomatic individuals with Brugada ECG pattern (BrECG).
• Risk stratification and long-term prognosis for this population remain critical areas of investigation.

Purpose of the Study:

• To assess the long-term prognosis of a large cohort of asymptomatic patients diagnosed with BrECG.
• To identify predictors of arrhythmic events in this patient group.

Main Methods:

• A cohort of 1149 asymptomatic patients with BrECG was followed for 2-22 years.
• Patients were stratified based on spontaneous type 1 BrECG or drug-induced type 1 BrECG.
• Electrophysiologic study (EPS) was utilized in a subset of patients with spontaneous type 1 BrECG.

Main Results:

• The overall annual event rate was low (0.2%), with 1.5% of patients experiencing arrhythmic events.
• Patients with spontaneous type 1 BrECG had a higher event rate (0.4% per year) compared to drug-induced type 1 BrECG (0.03% per year).
• Positive EPS in spontaneous type 1 BrECG patients was associated with significantly higher event rates (0.7% per year) versus negative EPS (0.2% per year).

Conclusions:

• Asymptomatic BrECG patients have a low overall annual arrhythmic risk.
• Spontaneous type 1 BrECG combined with a positive EPS identifies a subgroup requiring closer monitoring.
• Patients with drug-induced type 1 BrECG have minimal risk but warrant continued follow-up for potential spontaneous pattern development.