Low Disease Prevalence and Major Arrhythmic Events in Older Adults with Brugada Syndrome: a Systematic Review and Meta-analysis

The prevalence and prognosis of older adults with Brugada syndrome (BrS) are not well established. The aims of this systematic review and meta-analysis were to determine the disease prevalence as well as to explore the incidence of major arrhythmic events (MAE) in older adults with BrS. PubMed, Scopus, and Cochrane Library databases were searched from database inception to March 2021. Observational studies that enrolled BrS patients aged 60 and older and reported details of MAE were selected. Only patients with BrS type I ECG were examined. MAE included ventricular tachycardia/ventricular fibrillation, sudden cardiac death, and appropriate implantable cardioverter defibrillatory shock. We initially identified 2514 studies and finally retrieved 7 studies. A total of 8808 BrS patients, consisting of 1360 patients aged 60 years and older, were enrolled. Prevalence of BrS, firstly presented at the age of 60 or older, was 18% (95% CI, 14 to 23%). Male predominance was significantly lower in older adult arm (63% and 71.9%; OR, 0.61; 95% CI, 0.39–0.96). Moreover, older patients were less likely to initially present with MAE (OR, 0.59; 95% CI, 0.45–0.78). Only 9 patients from all included studies had experienced MAE at the age of 70. This meta-analysis supports an age-dependent effect on BrS, as the disease prevalence and MAE were lower in older adults. In particular, BrS patients at 70 years of age rarely develop MAE. Future studies are needed for conducting a better risk stratification score, which may include patients’ age as one of the parameters of interest.