Subcutaneous Implantable Defibrillator Therapy in Patients With Brugada Syndrome: Data From a Large Multicenter...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Brugada syndrome (BrS) patients benefit from implantable cardioverter-defibrillators (ICDs) for life-saving therapy.
• Transvenous ICDs carry a significant risk of long-term complications.
• Subcutaneous ICD (S-ICD) offers a promising alternative, but long-term data in BrS patients are limited.

Purpose of the Study:

• To evaluate the long-term efficacy and safety of S-ICD therapy in a large cohort of Brugada syndrome patients.
• To assess appropriate and inappropriate shock rates, device-related complications, and pacing needs in BrS patients with S-ICDs.

Main Methods:

• A multicenter study included 450 consecutive Brugada syndrome patients who received S-ICD implantation between 2014 and 2024.
• Median follow-up was 52 months.
• Analysis focused on shock outcomes, complications, and pacing requirements.

Main Results:

• Appropriate shocks occurred in 3% of patients (1.2% at 12 months) with 90% first-shock success.
• Inappropriate shocks occurred in 7% of patients (1.4% at 12 months).
• Lower shock zone programming and multiple suitable vectors were protective against inappropriate shocks. Device-related complications were reported in 4% of patients; 0.7% required antibradycardia pacing.

Conclusions:

• The S-ICD is a viable and effective alternative to transvenous ICDs for preventing sudden cardiac death in Brugada syndrome patients.
• S-ICD therapy demonstrates favorable long-term outcomes in this population, particularly for those without an indication for pacing.