Impact of physical activity on presentation and prognosis of Brugada syndrome

Brugada syndrome (BS) is a channelopathy associated with an increased risk of sudden cardiac death (SCD). Intense physical activity is a recognised trigger of life-threatening arrhythmias in long QT syndrome, catecholaminergic ventricular tachycardia syndrome and arrhythmogenic cardiomyopathy, but it is believed to be safe in BS. The objective of this study is to assess the impact of regular physical activity on the expression and prognosis of BS.

286 consecutive BS patients (aged 39.1±17.8 years old, 70.6% men) were included. Patients were classified according to the level of exercise and main discipline of sport they had practised.

190 (66.4%) were sedentary, 27 (9.4%) practised light exercise, 59 (20.6%) moderate and 10 (5.3%) intense. Patients engaged in 'mixed or endurance' types of exercise were diagnosed earlier than sedentary ones (HR: 2.1; 95% CI: 1.5 to 2.9; p<0.001) and experienced syncope at a younger age (24.9±16.2 vs 37.4±18.2 years; p=0.04). Physical activity was associated with ECG sport-related changes like bradycardia (Δ 6 bpm) and a shorter QTc (Δ 21 ms) and also to a higher ST elevation in right precordial leads (Δ 0.5 mm). Physical activity was not a predictor of arrhythmic events or SCD.

Regular physical activity was associated with a younger diagnosis and an earlier occurrence of syncopal episodes. BS patients engaged in 'mixed or endurance' sports have ECG changes associated with sport adaptation and higher ST segment elevation. Nevertheless, physical activity was not related to a higher arrhythmic risk in our cohort of patients with BS.