Female Brugada syndrome patients had similar long-term risk of lethal arrhythmic events as males (HR 0.60, P=0.22) despite lower VF inducibility and older age at diagnosis.
Does the arrhythmic risk of female Brugada syndrome patients differ from that of male patients?
Female patients with Brugada syndrome present at an older age and have a higher prevalence of family history of sudden death or VF, but their long-term risk of lethal arrhythmic events is comparable to that of male patients.
Absolute Event Rate: 0% vs 0%
Abstract Background There are some ethnic and gender differences in patients with Brugada syndrome (BrS), that is especially more prevalent among middle-aged men in Asia. However, the risk management of female patients with BrS remains unclear. Objective To investigate whether the arrhythmic risk of female BrS patients differs from that of male patients. Methods We retrospectively analyzed patients with BrS using the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination (JROAD-DPC) database (2016–2021). BrS was diagnosed by a type-1 ECG, and blindly confirmed by two special cardiologists. The primary outcome was the occurrence of lethal arrhythmic events (LAEs), defined as a composite of sudden cardiac death (SCD) and ventricular fibrillation (VF). As appropriate, statistical analyses were performed using Cox regression. Results A total of 740 patients with BrS (68 9.2% females, mean age: 45.3±12.7) who had been identified a type-1 ECG (69.5% spontaneous, 30.5% non-spontaneous) were enrolled from 68 hospitals in Japan. Female BrS patients were significantly older at diagnosis than males (52.9±11.4 vs. 44.5±12.6 years, p0.01) (Figure A). A family history of sudden death or VF under the age of 45 was more common in female than in male BrS patients (26.5% vs. 14.0%, p=0.01). However, there was no gender difference in the prevalence of spontaneous type-1 ECG (female: 63.2% vs. male: 70.2%) and the SCN5A positive (23.1% vs. 14.2%, respectively), although only 147 patients underwent genetic testing. On the other hand, among 337 symptomatic patients, 82 had a history of VF at diagnosis, but no gender difference was observed in the history of VF or syncope. However, VF inducibility by the electrophysiological study (EPS) was lower in females than in males (41.9% vs. 58.0%, P=0.06), and fewer females underwent implantable cardioverter defibrillator (ICD) implantation (47.1% vs. 60.9%, P=0.04). During a median follow-up of 56 months, LAEs occurred in 106 patients (6 8.8% females and 100 14.9% males), with no significant difference between female and male (Figure B) (Hazard Ratio 95% CI: 0.60 0.26–1.37, P=0.22). Further subgroup analyses of patients with ICD for secondary prevention (Figure C) and primary prevention of SCD (Figure D) also revealed no gender differences in the prognosis after diagnosis. Conclusions Female BrS patients are rare, present at an older age, and have a higher prevalence of family history of sudden death or VF, with lower VF inducibility by EPS than male, however, long-term risk of LAEs is comparable with male patients. Thus, female patients require the same risk management as male BrS patients.Figure A, B Figure C, D
Chishaki et al. (Sat,) reported a other. Female Brugada syndrome patients had similar long-term risk of lethal arrhythmic events as males (HR 0.60, P=0.22) despite lower VF inducibility and older age at diagnosis.