Long-term prognosis in patients with Brugada syndrome based on Class II indication for implantable cardioverter-defibrillator in the HRS/EHRA/APHRS Expert Consensus Statement: Multicenter study in Japan

Background The HRS/EHRA/APHRS Expert Consensus Statement for implantable cardioverter-defibrillator (ICD) in Brugada syndrome (BrS) has recently been published. However, the validity of the Class II indication for ICD in BrS patients is still unknown. Objective The purpose of this study was to evaluate the validity of the Class II indication for ICD implantation in the Consensus Statement with a large Japanese cohort of BrS. Methods Among 410 patients with BrS, a total of 213 consecutive BrS patients with the Class II indication for ICD implantation (mean age 53 ± 14 years, 199 men) were enrolled. Clinical outcomes were compared between patients with Class IIa (n = 66) and those with Class IIb (n = 147) indication according to the Consensus Statement. Results The incidence of cardiac events (documented ventricular tachyarrhythmias or sudden cardiac death) during follow-up of 62 ± 34 months was significantly higher in patients with Class IIa (n = 8, 2.2% per year) than those with Class IIb indication (n = 4, 0.5% per year; P = .01). Conclusion We confirmed that Class IIa indication identified a group of patients with increased risk compared to Class IIb indication for ICD in the Consensus Statement of 2013. In patients with Class II indication, the combination of a history of syncope and spontaneous type 1 ECG may be an important factor in distinguishing intermediate- from low-risk patients with BrS in Japan.