Long term efficacy of ICD in Brugada Syndrome

Long term efficacy of ICD in Brugada Syndrome

So far the only proven therapy to prevent sudden cardiac death in Brugada syndrome is the implantation of an ICD, though some medications like quinidine have been shown to reduce ICD shocks. Efficacy of ICD has been shown to be good in a long term study of Brugada Syndrome patients by Hernandez-Ojeda et al [1] from Prof. Brugada’s group in Spain.

Of the 370 patients with Brugada Syndrome 104 received an ICD.  21 patients had a total of 81 appropriate shocks over a mean follow up period of  9.3 years. This is would mean 2.2 per 100 person-years of appropriate ICD shocks. As expected, appropriate shocks were significantly higher in those who received the ICD for secondary prevention. Interestingly, all the four patients who received appropriate shocks in the primary prevention group had spontaneous type 1 ECG and inducible ventricular arrhythmias on electrophysiology study. This corroborates with previous reports from Brugada’s group on the utility of EP study in the disease, though other investigators have not been able to establish the same.

The rate of inappropriate shocks was 0.9 per 100 person-years, with 9 patients experiencing 37 inappropriate shocks. ICD related complications occurred in 21 patients, giving an incidence of 1.4 per 100 patient years. Of the total 3 deaths during the study period, one was due to electrical storm while the rest were due to non cardiovascular causes.

Reference

1. Hernandez-Ojeda J, Arbelo E, Borras R, Berne P, Tolosana JM, Gomez-Juanatey A, Berruezo A, Campuzano O, Sarquella-Brugada G, Mont L, Brugada R, Brugada J. Patients With Brugada Syndrome and Implanted Cardioverter-Defibrillators. Long-Term Follow-Up. J Am Coll Cardiol. 2017;70(16):1991-2002.