Yonsei Med J.  2014 Jan;55(1):37-45. 10.3349/ymj.2014.55.1.37.

Prognosis after Implantation of Cardioverter-Defibrillators in Korean Patients with Brugada Syndrome

• Son MK
• Byeon K
• Park SJ
• Kim JS
• Nam GB
• Choi KJ
• Kim YH
• Park SW
• Kim YH
• Park HW
• Cho JG
• On YK

• KMID: 1779884
• DOI: http://doi.org/10.3349/ymj.2014.55.1.37

Abstract

PURPOSE
Our study aims to analyze prognosis after implantable cardioverter-defibrillator (ICD) implantation in Korean patients with Brugada syndrome (BrS).
MATERIALS AND METHODS
This was a retrospective study of BrS patients implanted with an ICD at one of four centers in Korea between January 1998 and April 2012. Sixty-nine patients (68 males, 1 female) were implanted with an ICD based on aborted cardiac arrest (n=38, 55%), history of syncope (n=17, 25%), or induced ven tricular tachyarrhythmia on electrophysiologic study in asymptomatic patients (n=14, 20%). A family history of sudden cardiac death and a spontaneous type 1 electrocardiography (ECG) were noted in 13 patients (19%) and 44 patients (64%), respectively.
RESULTS
During a mean follow-up of 59+/-46 months, 4.6+/-5.5 appropri ate shocks were delivered in 19 patients (28%). Fourteen patients (20%) experienced 5.2+/-8.0 inappropriate shocks caused by supraventricular arrhythmia, lead failure, or abnormal sensing. Six patients were admitted for cardiac causes during follow-up, but no cardiac deaths occurred. An episode of aborted cardiac arrest was a significant predictor of appropriate shock, and the composite of cardiac events in the Cox pro portional hazard model [hazard ratio (95% confidence interval) was 11.34 (1.31-97.94) and 4.78 (1.41-16.22), respectively]. However, a spontaneous type 1 ECG was not a predictor of cardiac events.
CONCLUSION
Appropriate shock (28%) and inappropriate shock (20%) were noted during a mean follow-up of 59+/-46 months in Korean BrS patients implanted with an ICD. An episode of aborted cardiac ar rest was the most powerful predictor of cardiac events.

Keyword

Brugada syndrome; implantable cardioverter-defibrillator; sudden death; syncope; Korea

MeSH Terms

Adult
Brugada Syndrome/*therapy
Death, Sudden, Cardiac
*Defibrillators, Implantable
Electrocardiography
Female
Humans
Male
Middle Aged
Prognosis
Republic of Korea
Retrospective Studies
Treatment Outcome

Figure

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  Fig. 1 Kaplan-Meier analysis of cardiac event-free survival, based on initial clinical presentation. (A) Appropriate shock-free survival. (B) Cardiac admission-free survival. (C) Inappropriate shock-free survival. (D) Composite of events (appropriate shock, cardiac admission, and inappropriate shock). *p was obtained by the log-rank test comparing patients with a history of syncope to asymptomatic patients. †p was obtained by the log-rank test comparing patients with an episode of aborted cardiac arrest to asymptomatic patients.

• 

  Fig. 2 Kaplan-Meier analysis of cardiac event-free survival, based on the presence of a family history of sudden cardiac death. (A) Appropriate shock-free survival. (B) Cardiac admission-free survival. (C) Inappropriate shock-free survival. (D) Composite of events (appropriate shock, cardiac admission, and inappropriate shock). SCD indicates sudden cardiac death. *p was obtained by the log-rank test comparing patients with and without a family history of sudden cardiac death. SCD, sudden cardiac death.

• 

  Fig. 3 Kaplan-Meier analysis of cardiac event-free survival, based on the presence of a spontaneous type 1 ECG pattern. (A) Appropriate shock-free survival. (B) Cardiac admission-free survival. (C) Inappropriate shock-free survival. (D) Composite of events (appropriate shock, cardiac admission, and inappropriate shock). *p was obtained by the log-rank test comparing patients with and without a spontaneous type 1 ECG pattern. ECG, electrocardiography.

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