Unsafe Drug Use and Arrhythmic Events in Brugada Patients with ICD: Results of a Long-Term Follow-Up

Fernandes, Diogo de Almeida; António, Natália; Madeira, Marta; Sousa, Pedro; Ventura, Miguel; Cristóvão, João; Nascimento, José; Elvas, Luís; Gonçalves, Lino; Pego, Guilherme Mariano

doi:10.1007/s10557-018-6770-5

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“…A Portuguese study from 2018 on 30 patients with BrS and an ICD implanted found that 53.3% of the included patients had taken a nonrecommended drug, and that 6 out of 7 patients (85.7%) who had experienced appropriate ICD therapies had received a nonrecommended drug as opposed to 45.4% of patients without ICD therapies (difference borderline significant, P =0.062). 4 The authors found a mean time between therapies and unsafe drug use of 3.8±7.5 days. In our study, we found none of the registered appropriate ICD therapies to be preceded by a new prescription of any nonrecommended BrS drug, even though there were no significant differences in the types of nonrecommended drugs patients were treated with in the 2 studies.…”

Section: Discussionmentioning

confidence: 95%

“…To date, 1 small study by de Almeida Fernandes et al on 30 patients with BrS with ICDs examined self‐reported use of nonrecommended BrS drugs and found that approximately half of patients with BrS were in treatment with a drug that was not recommended. 4 Collectively, very little information on the overall use of nonrecommended BrS drugs among patients with BrS exists, and it is not known if its use is associated with adverse outcomes.…”

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confidence: 99%

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Use of Nonrecommended Drugs in Patients With Brugada Syndrome: A Danish Nationwide Cohort Study

Jespersen

Krøll

Bhardwaj

et al. 2023

JAHA

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Background Patients with Brugada syndrome (BrS) are recommended to avoid drugs that may increase their risk of arrhythmic events. We examined treatment with such drugs in patients with BrS after their diagnosis. Methods and Results All Danish patients diagnosed with BrS (2006–2018) with >12 months of follow‐up were identified from nationwide registries. Nonrecommended BrS drugs were grouped into drugs to “avoid” or “preferably avoid” according to http://www.brugadadrugs.org . Cox proportional hazards analyses were performed to identify factors associated with any nonrecommended BrS drug use, and logistic regression analyses were performed to examine associated risk of appropriate implantable cardioverter defibrillator therapy, mortality, and a combined end point indicating an arrhythmic event of delayed implantable cardioverter defibrillator implantation, appropriate implantable cardioverter defibrillator therapy, and mortality. During a median follow‐up of 6.8 years, 93/270 (34.4%) patients with BrS (70.4% male, median age at diagnosis 46.1 years [interquartile range, 32.6–57.4]) were treated with ≥1 nonrecommended BrS drugs. No difference in any nonrecommended BrS drug use was identified comparing time before BrS diagnosis (12.6%) with each of the 5 years following BrS diagnosis ( P >0.05). Factors associated with any nonrecommended BrS drug use after diagnosis were female sex (hazard ratio [HR]) 1.83 [95% CI, 1.15–2.90]), psychiatric disease (HR, 3.63 [1.89–6.99]), and prior use of any nonrecommended BrS drug (HR, 4.76 [2.45–9.25]). No significant association between any nonrecommended BrS drug use and implantable cardioverter defibrillator therapy (n=20/97, odds ratio [OR], 0.7 [0.2–2.4]), mortality (n=10/270, OR, 3.4 [0.7–19.6]), or the combined end point (n=38/270, OR, 1.7 [0.8–3.7]) was identified. Conclusions One in 3 patients with BrS were treated with a nonrecommended BrS drug after BrS diagnosis, and a BrS diagnosis did not change prescription patterns. More awareness of nonrecommended drug use among patients with BrS is needed.

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Section: Discussionmentioning

confidence: 95%

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confidence: 99%