Background
The role of programmed ventricular stimulation (PVS) in identifying
Brugada syndrome patients at highest risk for sudden death is uncertain.
Methods and Results
We performed a systematic review and pooled analysis of prospective
observational studies of Brugada syndrome patients without a history of
sudden cardiac arrest who underwent PVS. We estimated incidence rates and
relative hazards of cardiac arrest or ICD shock. We analyzed
individual-level data from 8 studies, comprising 1312 patients who
experienced 65 cardiac events (median follow-up of 38.3 months). A total of
527 patients were induced into arrhythmias with up to triple extrastimuli.
Induction was associated with cardiac events during follow-up (HR 2.66,
95%CI 1.44–4.92, P<0.001), with the greatest risk
observed among those induced with single or double extrastimuli. Annual
event rates varied substantially by syncope history, presence of spontaneous
type 1 ECG pattern, and arrhythmia induction. The lowest risk occurred in
individuals without syncope and with drug-induced type 1 patterns
(0.23%, 95%CI 0.05–0.68 [no induced
arrhythmia with up to double extrastimuli]; 0.45%,
95%CI 0.01–2.49 [induced arrhythmia]) and
the highest risk occurred in individuals with syncope and spontaneous type 1
patterns (2.55%, 95%CI 1.58–3.89 [no induced
arrhythmia]; 5.60%, 95%CI 2.98–9.58
[induced arrhythmia]).
Conclusions
In Brugada syndrome patients, arrhythmias induced with PVS are
associated with future ventricular arrhythmia risk. Induction with fewer
extrastimuli is associated with higher risk. However, clinical risk factors
are important determinants of arrhythmia risk, and lack of induction does
not necessarily portend low ventricular arrhythmia risk particularly in
patients with high-risk clinical features.
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