Surveillance after cardiac arrest in patients with Brugada syndrome without an implantable defibrillator: An alarm effect of the previous syncope

Calvo, David; Flórez, Juan P.; Valverde, Irene; Rubín, José M.; Pérez, Diego; Vasserot, Mar González; Rodríguez‐Reguero, Julian; Avanzas, Pablo; Hera, Jesús M. de la; Gómez, J.J. Gávira; Coto, Eliécer; Martínez–Camblor, Pablo; Morı́s, César

doi:10.1016/j.ijcard.2016.05.018

Cited by 10 publications

(9 citation statements)

References 18 publications

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“…Many studies have shown that syncope was an independent predictor of risk, and provided sufficient evidence (Brugada et al, 2004 ; Priori et al, 2012 ; Calvo et al, 2016 ). The presence of symptoms in patients was significantly associated with arrhythmic events (23 vs. 3.8%, P < 0.00001) in our analysis.…”

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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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: 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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“…BrS patients who suffered from previous syncope were more likely to exhibit EPS inducibility (Priori et al, 2013). Many studies provided sufficient evidence, showing that syncope was an independent predictor of risk (Brugada et al, 2004; Priori et al, 2012; Calvo et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Pooled Analysis of Risk Stratification of Spontaneous Type 1 Brugada ECG: Focus on the Influence of Gender and EPS

Sacher

Kusano

et al. 2019

Front. Physiol.

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Aims: Risk stratification of patients with Brugada syndrome (BrS) is vital for accurate prognosis and therapeutic decisions. Spontaneous Type 1 ST segment elevation is generally considered to be an independent risk factor for arrhythmic events. Other risk factors include gender, syncope, sudden cardiac arrest (SCA), and positive electrophysiological study (EPS). However, the further risk stratification of spontaneous type 1 combined with the other risk factors remains unclear. The present study pooled data from 4 large trials aiming to systematically evaluate the risk of spontaneous Type-1 ECG when combined with one or more of these other recognized risk factors.Methods: We searched for related studies published from November 2, 2002 to February 10, 2018 in PubMed, EMBASE, Cochrane Library, MEDLINE, Chinese National Knowledge Infrastructure (CNKI), and Wanfang Databases. The pooled data were evaluated combining each risk factor with the presence of a spontaneous Type-1 ECG. All analyses were performed using Review Manager, version 5.0.12.Results: Four eligible studies involving 1,338 patients (85% males, mean age: 48.1 ± 18.1 years) were enrolled. Spontaneous Type-1 ECG was associated with higher risk for ventricular tachycardia/fibrillation (VT/VF) than cases with non-Type 1 ECG in males (odds ratio: 95% CI: 1.84–5.17; P < 0.0001), but not in females (P = 0.29). Among spontaneous Type-1 cases with syncope or with positive EPS, the difference was not statistically significant (P = 0.06 and 0.07, respectively). Patients with Type-1 ECGs and positive EPS were at higher risk than those with negative EPS (95% CI: 1.10–5.04; P = 0.03). Pooled analysis showed an association of Spontaneous Type-1 ECG, Type-1 ECGs combined with male, and Type-1 ECGs combined with positive EPS between increased risk of arrhythmic events.Conclusion: Our results indicate that in BrS patients, a spontaneous Type-1 ECG is an independent risk factor for SCD in males, but not in females. A spontaneous Type-1 BrS is associated with a worse prognosis when combined with positive EPS

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“…This should include alerting the patient to the relevance of syncope as an alarm symptom that must be followed by immediate admission to an accident and emergency department for acute evaluation. [2]…”

Section: Syncope and Sudden Cardiac Arrestmentioning

confidence: 99%

“…Despite the wide spectrum of clinical manifestations, young and apparently healthy individuals are the most frequently affected by this devastating event. [1,2] During the last 20 years, the genetic basis of Brugada syndrome has been extensively investigated, leading to major changes in gene encoding of the alpha-subunit of the Nav1.5 ( SCN5A , driving the fast depolarising sodium current), the gene most frequently associated with functional abnormalities underlying arrhythmogenicity. However, testing identifies genetic disorders in only 20–30% of the patients analysed, indicating a big gap in knowledge and understanding of the genetic aetiology of the syndrome.…”

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confidence: 99%

Insights for Stratification of Risk in Brugada Syndrome

et al. 2019

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Brugada syndrome (BrS) is an inherited disease with an increased risk of sudden cardiac death (SCD). However, testing identifies genetic disorders in only 20–30% of patients analysed, indicating a gap in knowledge of its genetic aetiology. Diagnosis relies on ECG, and risk stratification in BrS patients is challenging, primarily because of the complexity of the issue. As a result, clinicians fail to provide the appropriate strategy for SCD prevention for many patients. Several variables and interventions are being studied to improve diagnostics and maximise patient protection. In addition, the scientific community must increase efforts to provide patient care according to knowledge and research for improving stratification of risk. In this article, the authors summarise contemporary evidence on clinical variables and provide an overview of future directions in risk stratification and SCD prevention.

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Surveillance after cardiac arrest in patients with Brugada syndrome without an implantable defibrillator: An alarm effect of the previous syncope

Cited by 10 publications

References 18 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

Pooled Analysis of Risk Stratification of Spontaneous Type 1 Brugada ECG: Focus on the Influence of Gender and EPS

Insights for Stratification of Risk in Brugada Syndrome

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