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Estimulación ventricular programada para la estratificación del riesgo en el síndrome de Brugada: un análisis

Jakub Sroubek¹, Vincent Probst¹, Andrea Mazzanti¹

¹From Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (J.S.); Service de Cardiologue du CHU de Nantes, CHU de Nantes, Hôpital Nord, Nantes, France (V.P.); Molecular Cardiology, IRCCS Fondazione Salvatore Maugeri, Pavia, Italy (A.M., C.N., S.G.P.); Dipartimento di Medicina, Molecolare Università di Pavia, Pavia, Italy (S.G.P.); Division of Cardiology, Casa di Cura Pederzoli, Peschiera del Garda, Verona, Italy (P.D.); Arrhythmia Unit, Cardiovascular Surgery and Cardiology Institute, Havana, Cuba (J.C.H.); Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (K.O., I.W.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy (A.Z., D.C.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec City, QC, Canada (J.C., I.N.); Department of Electrophysiology and Pacing, Onassis Cardiac Surgery Center, Athens, Greece (A.K., G.T.); Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y.); Cardiovascular Research Center and Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston (D.J.M., P.T.E., S.A.L.); Heart Centre AMC, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (A.W.); Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia (A.W.); Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France (F.S.); First Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany (M.B.); DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany (M.B.); Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA (P.T.E., S.A.L.); Department of Cardiology, General Hospital of Conegliano, Conegliano, Treviso, Italy (G.A.); and Lankenau I

|January 23, 2016

Resumen

La estimulación ventricular programada puede identificar pacientes con síndrome de Brugada en alto riesgo de muerte súbita. La inducción de arritmias, especialmente con menos estímulos, indica un mayor riesgo, pero los factores clínicos siguen siendo cruciales.

Área de la Ciencia:

Cardiología
Electrofisiología
La genética

Sus antecedentes:

El síndrome de Brugada es un trastorno genético asociado con un mayor riesgo de muerte súbita cardíaca.
La utilidad de la estimulación ventricular programada (PVS) en la estratificación del riesgo para el síndrome de Brugada sigue siendo objeto de debate.

Objetivo del estudio:

Evaluar sistemáticamente el papel del PVS en la identificación de pacientes con síndrome de Brugada con alto riesgo de eventos cardíacos repentinos.
Analizar la asociación entre las arritmias inducidas por PVS y los sucesos cardíacos posteriores.

Principales métodos:

Una revisión sistemática y un análisis conjunto de estudios prospectivos y observacionales.
Se incluyeron 1312 pacientes con síndrome de Brugada sin un paro cardíaco previo, que se sometieron a PVS.
Se analizaron los datos a nivel individual para estimar las tasas de incidencia y los riesgos de paro cardíaco o shock ICD.

Principales resultados:

La inducción de arritmias durante el PVS se asoció con un aumento de 2,66 veces en el riesgo de eventos cardíacos.
La inducción con menos estímulos (únicos o dobles) confería el riesgo más alto.
Las tasas anuales de eventos variaron significativamente según el historial de síncope, el ECG espontáneo de tipo 1 y la inducción de arritmias.

Conclusiones:

Las arritmias inducidas por PVS son un predictor significativo del riesgo futuro de arritmia ventricular en el síndrome de Brugada.
El número de extraestímulos requeridos para la inducción se correlaciona con el riesgo, siendo menos el más peligroso.
Los factores de riesgo clínico son críticos; la ausencia de inducción no garantiza un riesgo bajo, especialmente en pacientes de alto riesgo.

Palabras clave:

Síndrome de Brugada arritmias cardíacas muerte súbita, cardíaca electrofisiología evaluación de riesgos

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