A score model to predict risk of events in patients with Brugada Syndrome

Sieira, Juan; Conte, Giulio; Ciconte, Giuseppe; Chierchia, Gian‐Battista; Casado-Arroyo, Rubén; Baltogiannis, Giannis; Giovanni, Giacomo Di; Saitoh, Yukio; Juliá, Justo; Mugnai, Giacomo; Meir, Mark La; Wellens, Francis; Czapla, Jens; Pappaert, Gudrun; Asmundis, Carlo de; Brugada, Pedro

doi:10.1093/eurheartj/ehx119

Cited by 160 publications

(129 citation statements)

References 21 publications

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Section: Introductionmentioning

confidence: 99%

“…Risk stratification in patients with Brugada syndrome is challenging [1][2][3]. Several risk factors for arrhythmic events (sustained ventricular arrhythmia or sudden cardiac death [SCD]) have been identified, but the most robust predictors are a spontaneous type 1 Brugada electrocardiogram (ECG) pattern and presumed arrhythmogen- Sakhi ic syncope [1][2][3]. There is controversy over the predictive role of inducible sustained ventricular arrhythmia during electrophysiological study (EPS), but it seems to be informative for predicting arrhythmic risk in moderate-risk patients when using less aggressive stimulation protocols (up to double extrastimuli) [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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Outcome of Insertable Cardiac Monitors in Symptomatic Patients with Brugada Syndrome at Low Risk of Sudden Cardiac Death

et al. 2020

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Introduction: There is limited data on the experience with insertable cardiac monitors (ICMs) in patients with Brugada syndrome. Objective: To evaluate the outcome of ICM in symptomatic patients with Brugada syndrome who are at suspected low risk of sudden cardiac death (SCD). Methods: We conducted a prospective single-center cohort study including all symptomatic patients with Brugada syndrome who received an ICM (Reveal LINQ) between July 2014 and October 2019. The main indication for monitoring was to exclude ventricular arrhythmias as the cause of symptoms and to establish a symptom-rhythm relationship. Results: A total of 20 patients (mean age, 39 ± 12 years; 55% male) received an ICM during the study period. Nine patients (45%) had a history of syncope (presumed nonarrhythmogenic), and 5 patients had a recent syncope (< 6 months). During a median follow-up of 32 months (interquartile range, 11-36 months), 3 patients (15%) experienced an episode of nonsustained ventricular arrhythmia. No patient died suddenly or experienced a sustained ventricular arrhythmia, and no patient had a recurrence of syncope. Overall, 17 patients (85%) experienced symptoms during follow-up, of whom 10 patients had an ICM-detected arrhythmia. In 4 patients (20%), the ICM-detected arrhythmia was an actionable event. ICMguided management included antiarrhythmic drug therapy for symptomatic ectopic beats (n = 3), pulmonary vein isolation, and oral anticoagulation for atrial fibrillation (n = 1), electrophysiological study for risk stratification (n = 1), and pacemaker implantation for atrioventricular block (n = 1). Conclusions: An ICM can be used to exclude ventricular arrhythmias in symptomatic patients with Brugada syndrome at low risk of SCD. Furthermore, an ICM-detected arrhythmia changed clinical management in 20% of patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcome of Insertable Cardiac Monitors in Symptomatic Patients with Brugada Syndrome at Low Risk of Sudden Cardiac Death

et al. 2020

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“…However, it is reasonable to restrict indications only to high-risk patients, as indicated by the guidelines. Moreover, in addition to the indications provided in the guidelines, ICD implantation might be reasonable in subjects with multiple risk factors[11,25,26]. Finally, in controversial cases and/or in cases at low risk, it is a good rule to discuss indications, contraindications and complications with patients and their families, so that they are aware that there is still a risk, even though it is small.…”

Section: Resultsmentioning

confidence: 99%

“…Recently, Sieira et al[26], from Pedro Brugada’s group, proposed a score model to predict the risk of events in patients with Brugada Syndrome. The model includes several risk factors: Spontaneous type 1 ECG (1 point), early f-SCD (1 point), +EPS (2 points), syncope (2 points), sinus node dysfunction (3 points) and previous aborted SCD (4 points).…”

Section: Usefulness Of a Multiparametric Approach For Risk Stratificamentioning

confidence: 99%

Brugada type 1 electrocardiogram: Should we treat the electrocardiogram or the patient?

Delise¹,

Allocca²,

Sitta³

2017

WJC

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Patients with a Brugada type 1 electrocardiogram (ECG) pattern may suffer sudden cardiac death (SCD). Recognized risk factors are spontaneous type 1 ECG and syncope of presumed arrhythmic origin. Familial sudden cardiac death (f-SCD) is not a recognized independent risk factor. Finally, positive electrophysiologic study (+EPS) has a controversial prognostic value. Current ESC guidelines recommend implantable cardioverter defibrillator (ICD) implantation in patients with a Brugada type 1 ECG pattern if they have suffered a previous resuscitated cardiac arrest (class I recommendation) or if they have syncope of presumed cardiac origin (class IIa recommendation). In clinical practice, however, many other patients undergo ICD implantation despite the suggestions of the guidelines. In a 2014 cumulative analysis of the largest available studies (including over 2000 patients), we found that 1/3 of patients received an ICD in primary prevention. Interestingly, 55% of these latter were asymptomatic, while 80% had a + EPS. This means that over 30% of subjects with a Brugada type 1 ECG pattern were considered at high risk of SCD mainly on the basis of EPS, to which a class IIb indication for ICD is assigned by the current ESC guidelines. Follow-up data confirm that in clinical practice single, and often frail, risk factors overestimate the real risk in subjects with the Brugada type 1 ECG pattern. We can argue that, in clinical practice, many cardiology centers adopt an aggressive treatment in subjects with a Brugada type 1 ECG pattern who are not at high risk. As a result, many healthy persons may be treated in order to save a few patients with a true Brugada Syndrome. Better risk stratification is needed. A multi-parametric approach that considers the contemporary presence of multiple risk factors is a promising one.

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“…The strength of this study was that it only included probands, thereby avoiding selection bias of including more family members of severely affected families. Furthermore, familial history of SCD at young age was included in a recent risk score to predict SCD in BrS suggesting genetic background plays an important role in risk stratification (Sieira et al., ).…”

Section: Discussionmentioning

confidence: 99%

Genotype–phenotype relationship and risk stratification in loss‐of‐function SCN5A mutation carriers

Robyns

Nuyens

Vandenberk

et al. 2018

Noninvasive Electrocardiol

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A score model to predict risk of events in patients with Brugada Syndrome

Abstract: BS patients remain at risk many years after diagnosis. Early SCD in first-degree relatives and SND are risk factors for arrhythmic events. A simple risk score might help in the stratification and management of BS patients.

Cited by 160 publications

References 21 publications

Outcome of Insertable Cardiac Monitors in Symptomatic Patients with Brugada Syndrome at Low Risk of Sudden Cardiac Death

Outcome of Insertable Cardiac Monitors in Symptomatic Patients with Brugada Syndrome at Low Risk of Sudden Cardiac Death

Brugada type 1 electrocardiogram: Should we treat the electrocardiogram or the patient?

Genotype–phenotype relationship and risk stratification in loss‐of‐function SCN5A mutation carriers

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