Gender differences in patients with Brugada syndrome and arrhythmic events: Data from a survey on arrhythmic events in 678 patients

Milman, Anat; Gourraud, Jean‐Baptiste; Andorin, Antoine; Postema, Pieter G.; Sacher, Frédéric; Mabo, Philippe; Conte, Giulio; Giustetto, Carla; Sarquella-Brugada, Geòrgia; Hochstadt, Aviram; Kim, Sung Hwan; Juang, Jimmy J.M.; Maeda, Shingo; Takahashi, Yoshihide; Kamakura, Tsukasa; Aiba, Takeshi; Leshem, Eran; Michowitz, Yoav; Rahkovich, Michael; Mizusawa, Yuka; Arbelo, Elena; Huang, Zhengrong; Denjoy, Isabelle; Wijeyeratne, Yanushi D.; Napolitano, Carlo; Brugada, Ramón; Casado-Arroyo, Rubén; Champagne, Jean; Calò, Leonardo; Tfelt-Hansen, Jacob; Priori, Silvia G.; Takagi, Masahiko; Veltmann, Christian; Delise, Pietro; Corrado, Domenico; Behr, Elijah R.; Gaïta, Fiorenzo; Yan, Gan Xin; Brugada, Josép; Leenhardt, Antoine; Wilde, Arthur A.M.; Brugada, Pedro; Kusano, Kengo; Hirao, Kazuyuki; Nam, Gi Byoung; Probst, Vincent; Belhassen, Bernard

doi:10.1016/j.hrthm.2018.06.019

Cited by 63 publications

(42 citation statements)

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“…Similar outcomes were found in other studies (Gehi et al, 2006 ; Benito et al, 2008 ). New studies have confirmed those acknowledged results, and outlined a complex relationship between sex distribution and patient ethnicity and age (Milman et al, 2018 ).…”

Section: Discussionmentioning

confidence: 78%

“…Many reporters overserved that men with cardiac events had greater rates of spontaneous type 1 ECG, and among male patients with spontaneous type 1 ECG, cardiac events were more frequent (Benito et al, 2008 ; Sacher et al, 2013 ; Shi et al, 2018 ). Recent studies have indicated that females have less type 1 BrS ECG and lower inducibility rates than males (Milman et al, 2018 ). However, interestingly no statistically significant sex-related differences were found in our result.…”

Section: Discussionmentioning

confidence: 99%

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Gender Differences in Prognosis and Risk Stratification of Brugada Syndrome: A Pooled Analysis of 4,140 Patients From 24 Clinical Trials

Yuan

Tian

et al. 2018

Front. Physiol.

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Background: Male gender has been consistently shown to be a risk factor for a greater number of arrhythmic events in patients with Brugada Syndrome (BrS). However, there have been no large-scale comprehensive pooled analyses to statistically and systematically verify this association. Therefore, we conducted a pooled analysis on gender differences in prognosis and risk stratification of BrS with a largest sample capacity at present.Methods: We searched PubMed, Embase, Medline, Cochrane Library databases, Chinese National Knowledge Infrastructure, and Wanfang Data for relevant studies published from 2002 to 2017. The prognosis and risk stratification of BrS and risk factors were then investigated and evaluated according to gender.Results: Twenty-four eligible studies involving 4,140 patients were included in the analysis. Male patients (78.1%) had a higher risk of arrhythmic events than female patients (95% confidence interval: 1.46–2.91, P < 0.0001). Among the male population, there were statistical differences between symptomatic patients and asymptomatic patients (95% CI: 2.63–7.86, P < 0.00001), but in the female population, no statistical differences were found. In the female subgroup, electrophysiological study (EPS) positive patients had a tendency toward a higher risk of arrhythmic events than EPS-negative patients (95% CI: 0.93–29.77, P = 0.06).Conclusions: Male patients are at a higher risk of arrhythmic events than female patients. Within the male population, symptomatic patients have a significantly higher risk profile compared to asymptomatic patients, but no such differences are evident within the female population. Consequently, in the female population, the risk of asymptomatic patterns cannot be underestimated.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Gender Differences in Prognosis and Risk Stratification of Brugada Syndrome: A Pooled Analysis of 4,140 Patients From 24 Clinical Trials

Yuan

Tian

et al. 2018

Front. Physiol.

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“…Western and Asian countries 1,13,14 . The present study sought to compare the clinical, electrocardiographic (ECG), electrophysiologic (EP) and genetic characteristics of White and Asian patients participating in SABRUS.…”

Section: Sabrus Is a Multicenter Survey Of First Aes Documented In 67mentioning

confidence: 99%

Ethnic differences in patients with Brugada syndrome and arrhythmic events: New insights from Survey on Arrhythmic Events in Brugada Syndrome

et al. 2019

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Background There is limited information on ethnic differences between patients with Brugada syndrome (BrS) with arrhythmic events (AEs). Objectives To compare clinical, electrocardiographic (ECG), electrophysiologic (EP) and genetic characteristics between White and Asian BrS-patients with AE. Methods SABRUS is a multicenter survey from Western and Asian countries, gathering 678 BrSpatients with first documented AE. After excluding patients with other (n=14; 2.1%) or unknown (n=30; 4.4%) ethnicity, 364 (53.7%) Whites and 270 (39.8%) Asians comprised the study group. Results There was no difference in AE age onset (41.3±16.1 years in Whites vs. 43.3±12.3 years in Asians, P=0.285). Higher proportions of Whites were observed in pediatric and elderly populations. Asians were predominantly males (98.1% vs. 85.7% in Whites, P<0.001) and frequently presented with aborted cardiac arrest (ACA) (71.1% vs. 56%, P<0.001). Asians tended to display more spontaneous type 1 BrS-ECG (71.5% vs. 64.3%, P=0.068). Family history of sudden cardiac death (FHSCD) was noted more in Whites (29.1% vs. 11.5%, P<0.001), with higher rate of SCN5A mutation carriers (40.1% vs. 13.2% in Asians, P<0.001), as well as more fever-related AEs (8.5% vs. 2.9%, 0.011). No difference was observed between the two groups regarding prior history of syncope and ventricular arrhythmia inducibility. Conclusions There are important differences between Asian and White BrS-patients. Asian patients present almost exclusively as male adults, more often with ACA and spontaneous type 1 BrS-ECG. However, they have less FHSCD and markedly lower SCN5A mutation rates. The striking difference in SCN5A mutation rates should be tested in future studies.

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“…Thereinto, BrS is a rare heritable arrhythmia syndrome which is characterized by a coved‐type ST‐segment elevation in the right precordial leads on electrocardiogram (ECG), it has been suggested that Brugada syndrome increased the risk of sudden cardiac death (SCD) . Most BrS patients are males, who have a higher risk of arrhythmic events than females . While more than 20 BrS‐associated genes have been identified, only SCN5A has sufficient genetic evidence suggesting that it is a genetic cause of disease, accounting for 20%‐25% of BrS cases, Despite these advances, genetic testing is still not recommended for BrS risk stratification .…”

Section: Introductionmentioning

confidence: 99%

Brugada syndrome with SCN5A mutations exhibits more pronounced electrophysiological defects and more severe prognosis: A meta‐analysis

et al. 2019

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Whether the presence of SCN5A mutation is a predictor of BrS risk remains controversial, and patient selection bias may have weakened previous findings. Therefore, we performed this study to clarify the clinical characteristics and outcomes of BrS probands with SCN5A mutations. We systematically retrieved eligible studies published through October 2018. A total of 17 studies enrolling 1780 BrS patients were included. Overall, our results found that compared with BrS patients without SCN5A mutations, patients with SCN5A mutations exhibited a younger age at the onset of symptoms and higher rate of the spontaneous type-1 electrocardiogram pattern, more pronounced conduction or repolarization abnormalities, and increased atrial vulnerability. In addition, the presence of SCN5A mutations was associated with an elevated risk of major arrhythmic events in both Asian (odds ratio [OR] = 1.82, 95% confidence interval [CI] 1.07-3.11; P = .03) and Caucasian (OR = 2.24, 95% CI 1.02-4.90; P = .04) populations. In conclusions, patients with SCN5A mutations exhibit more pronounced electrophysiological defects and more severe prognosis.Clinicians should be cautious when utilizing genetic testing for risk stratification or treatment guidance before determining whether the causal relationship regarding SCN5A mutation status is an independent predictor of risk.

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Gender differences in patients with Brugada syndrome and arrhythmic events: Data from a survey on arrhythmic events in 678 patients

Cited by 63 publications

References 16 publications

Gender Differences in Prognosis and Risk Stratification of Brugada Syndrome: A Pooled Analysis of 4,140 Patients From 24 Clinical Trials

Gender Differences in Prognosis and Risk Stratification of Brugada Syndrome: A Pooled Analysis of 4,140 Patients From 24 Clinical Trials

Ethnic differences in patients with Brugada syndrome and arrhythmic events: New insights from Survey on Arrhythmic Events in Brugada Syndrome

Brugada syndrome with SCN5A mutations exhibits more pronounced electrophysiological defects and more severe prognosis: A meta‐analysis

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