Use of implantable loop recorders in patients with Brugada syndrome and suspected risk of ventricular arrhythmia

Kubala, Maciej; Aïssou, Linda; Traullé, Sarah; Gugenheim, A L; Hermida, Jean‐Sylvain

doi:10.1093/europace/eur319

Cited by 47 publications

(25 citation statements)

References 17 publications

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“…Implantable loop recorders (ILRs) provide a very close follow‐up and might be helpful in further risk stratification of asymptomatic individuals with potential risk factors. The use of ILR has been already tested in high‐risk subjects with Brugada ECG pattern and atypical symptoms . For asymptomatic individuals with drug‐induced ECG pattern, a close follow‐up with 12‐lead ECG Holter recordings that concomitantly records data form the 4 th , 3 rd , and 2 nd intercostal space in order to reveal a spontaneous diagnostic ECG pattern should be considered .…”

Section: Management Of Asymptomatic Individuals With Brugada Ecg Patternmentioning

confidence: 99%

“…The use of ILR has been already tested in high-risk subjects with Brugada ECG pattern and atypical symptoms. 113 For asymptomatic individuals with drug-induced ECG pattern, a close follow-up with 12-lead ECG Holter recordings that concomitantly records data form the 4 th , 3 rd , and 2 nd intercostal space in order to reveal a spontaneous diagnostic ECG pattern should be considered. 114 This strategy may have important implications in risk stratification of these patients.…”

Section: Follow-up Of Asymptomatic Patientsmentioning

confidence: 99%

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Prognosis, risk stratification, and management of asymptomatic individuals with Brugada syndrome: A systematic review

Letsas

Asvestas

Baranchuk

et al. 2017

Pacing Clinical Electrophis

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Brugada syndrome (BrS) is a primary electrical disease associated with increased risk of sudden cardiac death due to polymorphic ventricular arrhythmias. The prognosis, risk stratification, and management of asymptomatic individuals remain the most controversial issues in BrS. Furthermore, the decision to manage asymptomatic patients with an implantable cardioverter‐defibrillator should be made after weighing the potential individual risk of future arrhythmic events against the risk of complications associated with the implant and follow‐up of patients living with such devices, and the accompanying impairment of the quality of life. Several clinical, electrocardiographic, and electrophysiological markers have been proposed for risk stratification of subjects with BrS phenotype, but the majority have not yet been tested in a prospective manner in asymptomatic individuals. Recent data suggest that current risk factors are insufficient and cannot accurately predict sudden cardiac death events in this setting. This systematic review aims to discuss contemporary data regarding prognosis, risk stratification, and management of asymptomatic individuals with diagnosis of Brugada electrocardiogram pattern and to delineate the therapeutic approach in such cases.

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Section: Management Of Asymptomatic Individuals With Brugada Ecg Patternmentioning

confidence: 99%

Section: Follow-up Of Asymptomatic Patientsmentioning

confidence: 99%

Prognosis, risk stratification, and management of asymptomatic individuals with Brugada syndrome: A systematic review

Letsas

Asvestas

Baranchuk

et al. 2017

Pacing Clinical Electrophis

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“…Some symptoms are caused by anxiety for arrhythmic events, but it may be difficult to differentiate this from clinically relevant arrhythmias. Insertable cardiac monitors (ICM) are increasingly being used in doubtful cases to exclude ventricular arrhythmias as the cause of symptoms [5,10,11]. The recent ESC guidelines and expert consensus conference report support the use of ICMs in patients with Brugada syndrome and recurrent unexplained syncope [12,13].…”

Section: Introductionmentioning

confidence: 99%

Outcome of Insertable Cardiac Monitors in Symptomatic Patients with Brugada Syndrome at Low Risk of Sudden Cardiac Death

et al. 2020

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Introduction: There is limited data on the experience with insertable cardiac monitors (ICMs) in patients with Brugada syndrome. Objective: To evaluate the outcome of ICM in symptomatic patients with Brugada syndrome who are at suspected low risk of sudden cardiac death (SCD). Methods: We conducted a prospective single-center cohort study including all symptomatic patients with Brugada syndrome who received an ICM (Reveal LINQ) between July 2014 and October 2019. The main indication for monitoring was to exclude ventricular arrhythmias as the cause of symptoms and to establish a symptom-rhythm relationship. Results: A total of 20 patients (mean age, 39 ± 12 years; 55% male) received an ICM during the study period. Nine patients (45%) had a history of syncope (presumed nonarrhythmogenic), and 5 patients had a recent syncope (< 6 months). During a median follow-up of 32 months (interquartile range, 11-36 months), 3 patients (15%) experienced an episode of nonsustained ventricular arrhythmia. No patient died suddenly or experienced a sustained ventricular arrhythmia, and no patient had a recurrence of syncope. Overall, 17 patients (85%) experienced symptoms during follow-up, of whom 10 patients had an ICM-detected arrhythmia. In 4 patients (20%), the ICM-detected arrhythmia was an actionable event. ICMguided management included antiarrhythmic drug therapy for symptomatic ectopic beats (n = 3), pulmonary vein isolation, and oral anticoagulation for atrial fibrillation (n = 1), electrophysiological study for risk stratification (n = 1), and pacemaker implantation for atrioventricular block (n = 1). Conclusions: An ICM can be used to exclude ventricular arrhythmias in symptomatic patients with Brugada syndrome at low risk of SCD. Furthermore, an ICM-detected arrhythmia changed clinical management in 20% of patients.

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“…In 2011, Kubala et al9 published their experience with the use of ILRs in 11 BrS patients where there was clinical suspicion of ventricular arrhythmias. They identified bradycardia and atrioventricular block during syncopal episodes, but no ventricular arrhythmias.…”

Section: Introductionmentioning

confidence: 99%

Implantable Loop Recorder Monitoring for Refining Management of Children With Inherited Arrhythmia Syndromes

Silva

Bromberg

Emge³

et al. 2016

JAHA

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BackgroundImplantable loop recorders (ILRs) are conventionally utilized to elucidate the mechanism of atypical syncope. The objective of this study was to assess the impact of these devices on management of pediatric patients with known or suspected inherited arrhythmia syndromes.Methods and ResultsA retrospective chart review was undertaken of all pediatric patients with known or suspected inherited arrhythmia syndromes in whom an ILR was implanted from 2008 to 2015. Captured data included categorization of diagnosis, treatment, transmitted tracings, and the impact of ILR tracings on management. Transmissions were categorized as symptomatic, autotriggered, or routine. Actionable transmissions were abnormal tracings that directly resulted in a change of medical or device therapy. A total of 20 patients met the stated inclusion criteria (long QT syndrome, n=8, catecholaminergic polymorphic ventricular tachycardia,n=9, Brugada syndrome, n=1, arrhythmogenic right ventricular cardiomyopathy, n=2), with 60% of patients being genotype positive. Primary indication for implantation of ILR included ongoing monitoring +/− symptoms (n=15, 75%), suspicion of noncompliance (n=1, 5%), and liberalization of recommended activity restrictions (n=4, 25%). A total of 172 transmissions were received in patients with inherited arrhythmia syndromes, with 7% yielding actionable data. The majority (52%) of symptom events were documented in the long QT syndrome population, with only 1 tracing (5%) yielding actionable data. Automatic transmissions were mostly seen in the catecholaminergic polymorphic ventricular tachycardia cohort (81%), with 21% yielding actionable data. There was no actionable data in routine transmissions.ConclusionsILRs in patients with suspected or confirmed inherited arrhythmia syndromes may be useful for guiding management. Findings escalated therapies in 30% of subjects. As importantly, in this high‐risk population, the majority of symptom events represented normal or benign rhythms, reassuring patients and physicians that no further intervention was required.

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Use of implantable loop recorders in patients with Brugada syndrome and suspected risk of ventricular arrhythmia

Cited by 47 publications

References 17 publications

Prognosis, risk stratification, and management of asymptomatic individuals with Brugada syndrome: A systematic review

Prognosis, risk stratification, and management of asymptomatic individuals with Brugada syndrome: A systematic review

Outcome of Insertable Cardiac Monitors in Symptomatic Patients with Brugada Syndrome at Low Risk of Sudden Cardiac Death

Implantable Loop Recorder Monitoring for Refining Management of Children With Inherited Arrhythmia Syndromes

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