Electrophysiological Study Prognostic Value and Long-Term Outcome in Drug-Induced Type 1 Brugada Syndrome
Electrophysiological Study Prognostic Value and Long-Term Outcome in Drug-Induced Type 1 Brugada Syndrome
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DOI：
10.1016/j.jacep.2021.03.010
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发表时间：
2021-10-18
影响因子：
7
通讯作者：
Nesti, Martina
中科院分区：
文献类型：
--
作者：
Russo, Vincenzo;Pafundi, Pia Clara;Nesti, Martina
目的探讨电生理检查(EPS)对药物诱导的1型Brugada综合征(BRS)患者危险分层的远期疗效和预后的预测作用。背景BRS是一种遗传性心脏病，易发生心脏性猝死。关于药物诱导的1型BRS患者的长期结果，几乎没有真实世界的数据，关于风险分层的问题仍然没有答案。方法意大利Brugada综合征(IBRYD)研究是一项多中心的回顾性观察研究。来自9个意大利第三转诊机构的226名药物诱导的1型BRS患者被登记。主要终点是适当的植入性心律转复除颤器(ICD)治疗和心脏性猝死。作者进一步评估了ICD植入的临床预测因素，以及EPS诱发心律失常的临床预测因素，以及EPS作为相关结果的潜在危险因素。结果142例(62.8%)患者在EPS时因晕厥和/或诱发室性心律失常而发生ICD。在106个月的中位随访期间，11名患者(4.9%)经历了主要结局事件。ICD治疗8年来的年平均发病率为0.38%(四分位数范围：0%至1.47%)。EPS期间室性快速性心律失常的诱发率不能预测ICD受者与非ICD患者以及有症状与无症状亚组的心律失常事件，其阳性预测值较低(分别为9.6%和8.9%)，而阴性预测值较高(分别为96.6%和95%)。作者报告了29例ICD相关并发症和4.9%的不适当电击。结论药物所致的1型BRS患者发生心律失常的风险很低。晕厥和/或EPS阳性支持植入的临床决定，尽管它们无法对高危患者进行分层。考虑到心律失常的风险和ICD相关的并发症，应该追求更好的风险收益比。(J Am Coll心脏ol EP 2021；7：1264-1273)(C)2021，由美国心脏病学会基金会提供。
OBJECTIVES This study aimed to retrospectively assess long-term outcome and the prognostic role of electrophysi-ological study (EPS) for risk stratification of drug-induced type 1 Brugada syndrome (BrS) patients. BACKGROUND BrS is a hereditary cardiac disease, predisposing to sudden cardiac death. Few real-world data are available on long-term outcomes of drug-induced type 1 BrS patients, and questions about risk stratification still remain unanswered. METHODS The IBRYD (Italian Brugada Syndrome) study is a multicenter observational retrospective study. A total of 226 drug-induced type 1 BrS patients were enrolled from 9 Italian tertiary referral institutions. Primary endpoint was a composite of appropriate implantable cardioverter-defibrillator (ICD) therapy and sudden cardiac death. The authors further assessed clinical predictors to ICD implantation, as well as for arrhythmia induction at EPS, along with EPS as potential risk factor for the outcomes of interest. RESULTS 142 patients (62.8%) received an ICD due to syncope and/or inducible ventricular tachyarrhythmias at EPS. During a median follow-up of 106 months, 11 patients (4.9%) experienced primary outcome events. The ICD therapy median annual incidence over 8 years was 0.38% (interquartile range: 0% to 1.47%). Ventricular tachyarrhythmia inducibility during EPS was not predictive of arrhythmic events in ICD recipients versus non-ICD patients and in symp-tomatic versus asymptomatic subgroups, showing a low positive predictive value (9.6% and 8.9%, respectively) versus a high negative predictive value (96.6% and 95%, respectively). The authors reported 29 ICD-related complications and 4.9% inappropriate shocks. CONCLUSIONS Drug-induced type 1 BrS patients have a very low arrhythmic risk. Clinical decision for implantation is supported by syncope and/or EPS positivity, though they fail to stratify high-risk patients. A better risk-to-benefit ratio should be pursued, considering both arrhythmic risk and ICD-related complications. (J Am Coll Cardiol EP 2021;7:1264-1273) (c) 2021 by the American College of Cardiology Foundation.