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2021, Number 2

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Rev Cubana Cardiol Cir Cardiovasc 2021; 27 (2)

Clinical course of patients with Brugada syndrome and implanted automatic defibrillators. Experience in two tertiary care centers

Castro HJ, Castañeda CO, Martínez LF, Falcón RR, Dorantes SM, Cruz CM, de Zayas GY, de la Vega VK, Mengana BA, Quiñones MI, Gutiérrez LA

Language: Spanish
References: 49
Page:
PDF size: 853.51 Kb.


ABSTRACT

Introduction: Implantable cardioverter-defibrillator (ICD) is a therapeutic option in high-risk patients with Brugada syndrome (BS). The objective was to describe clinical evolution of patients with BS and ICD in two tertiary care centers.
Methods: Between April/1998 and November/2019, ICD were implanted in 64 patients with BS. Follow-up was carried out at 1 month, 3 months and every six months.
Results: Nineteen debuted with aborted sudden cardiac death (SCD), 36 with syncope and 9 were asymptomatic, mean age 43.8 years, 49 were male. Basal coved ECG in at least one right precordial lead was documented in 96.2% and 12 had first grade relatives of SCD. Programmed electrical stimulation was performed in 52, 12 were inducible. Fourteen had complications related to generator/electrode system and 19 had inappropriate shocks. Two patients took quinidine sulfate since implantation due to atrial arrhythmias and two died in unclear circumstances, of the rest, in a mean follow-up of 120.5 ± 74.8 months, 17 (28.3%) had appropriate shocks, 12 had debuted with SCD and 5 with syncope. Risk factors for life-threatening ventricular arrhythmias were: male sex, aborted SCD, longer follow-up, and inappropriate shocks. According Kaplan Meier curves, survival free of appropriate shocks was lower in patients with symptoms versus asymptomatic (p=0.042), and those who presented SCD compared who had syncope (p=0.0034).
Conclusions: Symptomatic patients with BS are at high risk. Long-term complications associated with ICD are noteworthy. The decision to implant defibrillators in asymptomatic patients continues to be a clinical challenge.


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