Retrospective Analysis of Patients with Brugada Syndrome and Implantable Cardioverter Defibrillator

Introduction: The Brugada syndrome is an inherited, electrical anomaly, with increased risk ofsudden cardiac death. Automatic cardioverter defibrillators are the only effective treatment to prevent sudden cardiac death, while therapy management in asymptomatic patients is still controversial. Objectives: The aims of the study were to evaluate the incidence and causes of appropriate and inappropriate shocks and the complications related to the device, and to identify the relationship of clinical and electrophysiological study variables with the incidence ofappropriate shocks. Methods: This was a single-center, retrospective registry of patients with type-1 electrocardiographic Brugada syndrome, either spontaneous or induced by ajmaline infusion, whowere recipients of automatic implantable cardioverter defibrillator. Results: Twenty-one patients were included in the study; 18 men, with average age of 40 years. The device was indicated due to the following symptoms: nocturnal agonalrespiration, syncope and resuscitated cardiac arrest, or positive electrophysiologicalstudy in asymptomatic patients. There were no deaths during follow-up of 88 months, and the annual rate of appropriate shocks was 1.9%, below that of inappropriate shocks (7.5%). Ten patients presented complications including device infection and psychiatric disorders. The only variable significantly related with the presence of appropriate shocks was history of fibrillation and atrial flutter. Conclusions: A low annual rate of appropriate shocks was observed. The difficulties in risk stratification, the high incidence of inappropriate shocks and the high frequency of complication sindicate need of careful patient selection for the implantation of thesedevices until more reliable predictors of arrhythmic risk are found.