Pathogenesis and Management of Brugada Syndrome: Recent Advances and Protocol for Umbrella Reviews of Meta-Analyses in Major Arrhythmic Events Risk Stratification

Abstract

Brugada syndrome (BrS) is a primary electrical disease associated with life-threatening arrhythmias. It is estimated to cause at least 20% of sudden cardiac deaths (SCDs) in patients with normal cardiac anatomy. In this review paper, we discuss recent advances in complex BrS pathogenesis, diagnostics, and current standard approaches to major arrhythmic events (MAEs) risk stratification. Additionally, we describe a protocol for umbrella reviews to systematically investigate clinical, electrocardiographic, electrophysiological study, programmed ventricular stimulation, and genetic factors associated with BrS, and the risk of MAEs. Our evaluation will include MAEs such as sustained ventricular tachycardia, ventricular fibrillation, appropriate implantable cardioverter–defibrillator therapy, sudden cardiac arrest, and SCDs from previous meta-analytical studies. The protocol was written following the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guidelines. We plan to extensively search PubMed, Embase, and Scopus databases for meta-analyses concerning risk-stratification in BrS. Data will be synthesized integratively with transparency and accuracy. Heterogeneity patterns across studies will be reported. The Joanna Briggs Institute (JBI) methodology, A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2), and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) are planned to be applied for design and execution of our evidence-based research. To the best of our knowledge, these will be the first umbrella reviews to critically evaluate the current state of knowledge in BrS risk stratification for life-threatening ventricular arrhythmias, and will potentially contribute towards evidence-based guidance to enhance clinical decisions.

Attendance-related Healthcare Resource Utilisation and Costs in Patients With Brugada Syndrome in Hong Kong: A Retrospective Cohort Study

“…There is well-established evidence proposing the association between BrS and increased risks of VT/VF and SCD. 21,22 However, the optimal management of BrS patients remains a challenge in the health care setting with difficulties in accurate risk stratification. 23,24 The use of an ICD has shown to be effective in averting the occurrence of SCD for BrS patients.…”

Neuroimaging Studies of the Neural Correlates of Heart Rate Variability: A Systematic Review

“…Although this field is in its infancy, it promises to provide insights into brain-heart interactions and their relationship to health and disease and potentially also into pathways by which psychosocial factors can influence them. Umbrella reviews and quantitative analyses, as in other fields of clinical medicine, [83] could be valuable.…”

Secular trends of health care resource utilization and costs between Brugada syndrome and congenital long QT syndrome: A territory‐wide study

“…4 Therefore, this presents a greater challenge in risk stratification and clinical management of BrS. [5][6][7] However, there is little understanding of the healthcare burden of LQTS and BrS patients. The provision of genetic testing options, implantable cardioverter-defibrillators (ICD), hospital admissions from arrhythmia-related symptoms, and the need for specialist outpatient services follow-up for device and arrhythmia management and monitoring are major drivers for health care expenditure.…”

“…In contrast, the interpretation of genetic variants in BrS is difficult, with approximately 25% of cases attributed to SCN5A mutations 4 . Therefore, this presents a greater challenge in risk stratification and clinical management of BrS 5–7 …”