(Representative image from BMH Med. J. 2016;3(2):29-31)
Efficacy of ICD (Implantable Cardioverter Defibrillator) has to be shown to be good in a long term study of Brugada Syndrome patients by Hernandez-Ojeda et al  from Prof. Brugada’s group in Spain. Of the 370 patients with Brugada Syndrome 104 received an ICD (28.1%). 21 patients had a total of 81 appropriate shocks over a follow up period of 9.3 ± 5.1 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 (p<0.01). Interestingly, all the four patients who received appropriate shocks (8.1%) in the primary prevention group had spontaneous type 1 ECG and inducible ventricular arrhythmias on EP (electrophysiology) study. This corroborates with previous reports from Brugada’s group on the utility of EP study in Brugada Syndrome, though other investigators have not been able to establish the utility of EP study in Brugada syndrome.
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.
- Hernandez-Ojeda J et al. Patients With Brugada Syndrome and Implanted Cardioverter-Defibrillators. Long-Term Follow-Up. J Am Coll Cardiol. 2017;70(16):1991-2002.