Programmed electrical stimulation inducibility did not predict arrhythmic events in Brugada syndrome, whereas spontaneous type I ECG, syncope, ERP <200 ms, and QRS fragmentation were predictive.
Cohort (n=308)
Does programmed electrical stimulation-induced VT/VF predict arrhythmic events in patients with Brugada syndrome without prior cardiac arrest?
In Brugada syndrome patients without prior cardiac arrest, VT/VF inducibility during programmed electrical stimulation does not predict future arrhythmic events, whereas spontaneous type I ECG, syncope, short ventricular refractory period, and QRS fragmentation are strong predictors.
OBJECTIVES: The PRELUDE (PRogrammed ELectrical stimUlation preDictive valuE) prospective registry was designed to assess the predictive accuracy of sustained ventricular tachycardia/ventricular fibrillation (VTs/VF) inducibility and to identify additional predictors of arrhythmic events in Brugada syndrome patients without history of VT/VF. BACKGROUND: Brugada syndrome is a genetic disease associated with increased risk of sudden cardiac death. Even though its value has been questioned, inducibility of VTs/VF is widely used to select candidates to receive a prophylactic implantable defibrillator, and its accuracy has never been addressed in prospective studies with homogeneous enrolling criteria. METHODS: Patients with a spontaneous or drug-induced type I electrocardiogram (ECG) and without history of cardiac arrest were enrolled. The registry included 308 consecutive individuals (247 men, 80%; median age 44 years, range 18 to 72 years). Programmed electrical stimulation was performed at enrollment, and patients were followed-up every 6 months. RESULTS: During a median follow-up of 34 months, 14 arrhythmic events (4.5%) occurred (13 appropriate shocks of the implantable defibrillator, and 1 cardiac arrest). Programmed electrical stimulation performed with a uniform and pre-specified protocol induced ventricular tachyarrhythmias in 40% of patients: arrhythmia inducibility was not a predictor of events at follow-up (9 of 14 events occurred in noninducible patients). History of syncope and spontaneous type I ECG (hazard ratio HR: 4.20), ventricular refractory period <200 ms (HR: 3.91), and QRS fragmentation (HR: 4.94) were significant predictors of arrhythmias. CONCLUSIONS: Our data show that VT/VF inducibility is unable to identify high-risk patients, whereas the presence of a spontaneous type I ECG, history of syncope, ventricular effective refractory period <200 ms, and QRS fragmentation seem useful to identify candidates for prophylactic implantable cardioverter defibrillator.
Priori et al. (2011) conducted a cohort in Brugada syndrome (n=308). Programmed electrical stimulation was evaluated on Arrhythmic events (appropriate shocks of the implantable defibrillator, and cardiac arrest). Programmed electrical stimulation inducibility did not predict arrhythmic events in Brugada syndrome, whereas spontaneous type I ECG, syncope, ERP <200 ms, and QRS fragmentation were predictive.