Outcome After Implantation of a Cardioverter-Defibrillator in Patients With Brugada Syndrome A Multicenter Study-Part 2
Outcome After Implantation of a Cardioverter-Defibrillator in Patients With Brugada Syndrome A Multicenter Study-Part 2
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DOI：
10.1161/circulationaha.113.001941
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发表时间：
2013-10-15
期刊：
影响因子：
37.8
通讯作者：
Haissaguerre, Michel
中科院分区：
文献类型：
--
作者：
Sacher, Frederic;Probst, Vincent;Haissaguerre, Michel
背景植入式心律转复除颤器在Brugada综合征中的适应症仍然存在争议，特别是在无症状患者中。以前的结果数据受到患者数量相对较少或随访时间较短的限制。我们报告植入植入式心律转复除颤器的Brugada综合征患者在一个大型的多中心registration.Methods和结果共378例（310名男性;年龄，4613岁）与1型Brugada心电图模式植入植入式心律转复除颤器（31流产心脏骤停，181晕厥，166无症状）的结果。15例患者（4%）失访。在平均77 +/- 42个月的随访期间，7例患者（2%）死亡（1例因不当电击），46例患者（12%）接受了适当的器械治疗（每例患者5 +/- 5次电击）。植入式心律转复除颤器适应症为心脏骤停中止的患者10年时的适当器械治疗率为48%，适应症为晕厥的患者为19%，植入时无症状的患者为12%。10年时，不适当电击和电极导线失效的发生率分别为37%和29%。91例患者（24%;每例患者4 +/- 4次电击）因电极导线故障（n=38）、室上性心动过速（n=20）、T波过感知（n=14）或窦性心动过速（n=12）发生不当电击。重要的是，引入远程监测，编程一个高的单心室颤动区（>210-220 bpm），和一个长的检测时间与不适当shock.Conclusions的风险降低适当的治疗是更普遍的有症状的Brugada综合征患者，但在无症状的患者（1%/y）并不显着。最佳的植入式心律转复除颤器程控和随访可显著减少不当电击。然而，导线失效仍然是这一人群的主要问题。
Background Implantable cardioverter-defibrillator indications in Brugada syndrome remain controversial, especially in asymptomatic patients. Previous outcome data are limited by relatively small numbers of patients or short follow-up durations. We report the outcome of patients with Brugada syndrome implanted with an implantable cardioverter-defibrillator in a large multicenter registry.Methods and Results A total of 378 patients (310 male; age, 4613 years) with a type 1 Brugada ECG pattern implanted with an implantable cardioverter-defibrillator (31 for aborted sudden cardiac arrest, 181 for syncope, and 166 asymptomatic) were included. Fifteen patients (4%) were lost to follow-up. During a mean follow-up of 77 +/- 42 months, 7 patients (2%) died (1 as a result of an inappropriate shock), and 46 patients (12%) had appropriate device therapy (5 +/- 5 shocks per patient). Appropriate device therapy rates at 10 years were 48% for patients whose implantable cardioverter-defibrillator indication was aborted sudden cardiac arrest, 19% for those whose indication was syncope, and 12% for the patients who were asymptomatic at implantation. At 10 years, rates of inappropriate shock and lead failure were 37% and 29%, respectively. Inappropriate shock occurred in 91 patients (24%; 4 +/- 4 shocks per patient) because of lead failure (n=38), supraventricular tachycardia (n=20), T-wave oversensing (n=14), or sinus tachycardia (n=12). Importantly, introduction of remote monitoring, programming a high single ventricular fibrillation zone (>210-220 bpm), and a long detection time were associated with a reduced risk of inappropriate shock.Conclusions Appropriate therapies are more prevalent in symptomatic Brugada syndrome patients but are not insignificant in asymptomatic patients (1%/y). Optimal implantable cardioverter-defibrillator programming and follow-up dramatically reduce inappropriate shock. However, lead failure remains a major problem in this population.