Systematic Review for the 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

Abstract

Evidence from 6 studies of 1138 asymptomatic patients were identified. Brugada syndrome with inducible VA on electrophysiological study was identified in 390 (34.3%) patients. To minimize patient overlap, the primary analysis used 5 of the 6 studies and found an odds ratio of 2.3 (95% CI: 0.63-8.66; p=0.2) for major arrhythmic events (sustained VAs, sudden cardiac death, or appropriate ICD therapy) in asymptomatic patients with Brugada syndrome and inducible VA on electrophysiological study versus those without inducible VA. Ten studies were reviewed that evaluated ICD use in older patients and 4 studies that evaluated unique patient populations were identified. In our analysis, ICD implantation was associated with improved survival (overall hazard ratio: 0.75; 95% confidence interval: 0.67-0.83; p<0.001). Ten studies were identified that evaluated ICD use in patients with various comorbidities including renal disease, chronic obstructive pulmonary disease, atrial fibrillation, heart disease, and others. A random effects model demonstrated that ICD use was associated with reduced all-cause mortality (overall hazard ratio: 0.72; 95% confidence interval: 0.65-0.79; p<0.0001), and a second "minimal overlap" analysis also found that ICD use was associated with reduced all-cause mortality (overall hazard ratio: 0.71; 95% confidence interval: 0.61-0.82; p<0.0001). In 5 studies that included data on renal dysfunction, ICD implantation was associated with reduced all-cause mortality (overall hazard ratio: 0.71; 95% confidence interval: 0.60-0.85; p<0.001).

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

“…Whether EPS inducibility is a predictor of arrhythmic events in BrS patients with previous syncope/sudden death or an independent character remains in dispute (Brugada et al, 2002 , 2004 ; Priori et al, 2002 ; Giustetto et al, 2009 ). In the 2017 AHA/ACC/HRS guideline for ventricular arrhythmias and SCD, an EPS with programmed ventricular stimulation using single or double extrastimuli may be considered for further risk stratification in asymptomatic and spontaneous type 1patients (Kusumoto et al, 2017 ). Newly studies suggested that extent of substrate is the only independent predictor of inducibility of VT or VF and may contribute to a new marker for risk stratification and therapy (Pappone et al, 2018 ).…”

Brugada Syndrome: Progress in Genetics, Risk Stratification and Management

“…The role of EPS in the risk stratification of BrS patients has been debated for years, yet it still remains controversial owing to inconsistent results among different studies[29,30,35–29] and meta-analyses. [39,40] The reason for different observations in various studies is likely multifactorial, including patient populations (e.g. the percentage of patients with symptoms at presentation, spontaneous versus drug-induced type 1 ECG pattern), different protocols for programmed stimulations (e.g.…”

Ambulatory Electrocardiographic Monitoring and Ectopic Beat Detection in Conscious Mice

“…This extended monitoring period is associated with an improved diagnostic yield [ 5 ]. The European Society of Cardiology guidelines suggest that patients who have arrhythmia-related symptoms should receive a 24-h ambulatory ECG, in order to detect potential detrimental ventricular arrhythmia and conduction disorders and preventing SCD [ 6 , 7 ]. The most common finding on AECG are ectopic heart beats: premature atrial complexes (PACs) and premature ventricular complexes (PVCs) originating from the atrial and ventricular myocardium, respectively [ 8 ].…”