Long-term predictors of outcome in Brugada syndrome patients after implantable cardioverter-defibrillator implant.
- 1Department of Molecular Medicine, University of Pavia, Via Adolfo Ferrata, Pavia 27100, Italy.
- 2Molecular Cardiology Unit Istituti Clinici Scientifici Maugeri IRCCS, Via Maugeri 10, Pavia 27100, Italy.
- 3Cardiothoracic Department IRCCS Galeazzi-Sant' Ambrogio, Arrhythmia and Electrophysiology Unit, Milan, Italy.
Abstract
Aims
Various clinical risk factors impact the natural history of Brugada syndrome (BrS) and establish the basis of current clinical practice guidelines (CPG) indications for implantable cardioverter-defibrillator (ICD). Due to the time-dependent expressivity of BrS, their performance in predicting the actual occurrence of arrhythmic events after ICD implantation remains unknown.Objectives
To assess the occurrence of arrhythmic events based on the CPG indications and whether the genetic substrate can add to the prediction of arrhythmic events at follow-up.Methods and results
We enrolled consecutive patients who underwent ICD implant either for primary or secondary prevention. Prospective clinical data included arrhythmic history, electrocardiographic findings, therapies, SCN5A gene mutations, and genotyping of three BrS-associated single nucleotide variants. Eleven per cent of 551 patients experienced life-threatening arrhythmic events (LAE) over a median follow-up of 8.1 years. Patients with ESC class IIA indication had a similar risk profile as those implanted for secondary prevention. The recently developed BrS 5-year risk score, including clinical and genetic variables, was a determinant of outcome in the whole cohort and in patients implanted for primary prevention: 26.93 ± 3.33 vs. 4.41 ± 0.61 and 11.67 ± 1.52 vs. 5.36 ± 0.99 in patients with LAEs compared with those without events (P < 0.0001).Conclusion
CPG class IIa and I had a similar rate of ICD shock at follow-up. We also provide robust evidence indicating that the quantification of the BrS arrhythmic risk score at the moment of ICD implant may improve the identification of patients who will benefit from ICD at follow-up.
Related
- Failure of Implantable Cardioverter-defibrillator Pacing Capture in BRASH Syndrome with Severe Hyperkalemia.
- Radiofrequency ablation with a conventional solid tip catheter in contact with an implantable cardioverter-defibrillator coil causing inadvertent ventricular fibrillation.
- Ventricular fibrillation treated by an implantable cardioverter-defibrillator in antimitochondrial M2 antibody-positive myocarditis.
- Transient defibrillation threshold elevation associated with air in the generator pocket after extravascular implantable cardioverter-defibrillator implantation.
- Intraoperative preservation of an extravascular implantable cardioverter-defibrillator lead during coronary artery bypass grafting.
BibTeX
@article{napolitano2026longterm,
title = {{Long-term predictors of outcome in Brugada syndrome patients after implantable cardioverter-defibrillator implant.}},
author = {Carlo Napolitano and Camilla Pizzetti and Deni Kukavica and Massimo Morini and Luca Ottaviano and Umberto Giordano and Mirella Memmi and Patrick Gambelli and Andrea Mazzanti and Lucia Coppini and Alessandro Trancuccio and Gianluca Pili and Silvia G Priori},
journal = {Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology},
year = {2026},
month = oct,
doi = {10.1093/europace/euag278},
url = {https://europepmc.org/article/MED/42905523},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Long-term predictors of outcome in Brugada syndrome patients after implantable cardioverter-defibrillator implant.
AU - Carlo Napolitano
AU - Camilla Pizzetti
AU - Deni Kukavica
AU - Massimo Morini
AU - Luca Ottaviano
AU - Umberto Giordano
AU - Mirella Memmi
AU - Patrick Gambelli
AU - Andrea Mazzanti
AU - Lucia Coppini
AU - Alessandro Trancuccio
AU - Gianluca Pili
AU - Silvia G Priori
PY - 2026
DA - 2026/10/01
JO - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
DO - 10.1093/europace/euag278
UR - https://europepmc.org/article/MED/42905523
AB - Aims Various clinical risk factors impact the natural history of Brugada syndrome (BrS) and establish the basis of current clinical practice guidelines (CPG) indications for implantable cardioverter-defibrillator (ICD). Due to the time-dependent expressivity of BrS, their performance in predicting the actual occurrence of arrhythmic events after ICD implantation remains unknown.Objectives To assess the occurrence of arrhythmic events based on the CPG indications and whether the genetic substrate can add to the prediction of arrhythmic events at follow-up.Methods and results We enrolled consecutive patients who underwent ICD implant either for primary or secondary prevention. Prospective clinical data included arrhythmic history, electrocardiographic findings, therapies, SCN5A gene mutations, and genotyping of three BrS-associated single nucleotide variants. Eleven per cent of 551 patients experienced life-threatening arrhythmic events (LAE) over a median follow-up of 8.1 years. Patients with ESC class IIA indication had a similar risk profile as those implanted for secondary prevention. The recently developed BrS 5-year risk score, including clinical and genetic variables, was a determinant of outcome in the whole cohort and in patients implanted for primary prevention: 26.93 ± 3.33 vs. 4.41 ± 0.61 and 11.67 ± 1.52 vs. 5.36 ± 0.99 in patients with LAEs compared with those without events (P < 0.0001).Conclusion CPG class IIa and I had a similar rate of ICD shock at follow-up. We also provide robust evidence indicating that the quantification of the BrS arrhythmic risk score at the moment of ICD implant may improve the identification of patients who will benefit from ICD at follow-up.
SN - 1099-5129
SN - 1532-2092
ER -