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(Circulation. 2006;114:2317-2324.)
© 2006 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Outcome After Implantation of a Cardioverter-Defibrillator in Patients With Brugada Syndrome

A Multicenter Study

Frédéric Sacher, MD; Vincent Probst, MD, PhD; Yoshito Iesaka, MD; Peggy Jacon, MD; Julien Laborderie, MD; Frédérique Mizon-Gérard, MD; Philippe Mabo, MD; Sylvain Reuter, MD; Dominique Lamaison, MD; Yoshihide Takahashi, MD; Mark D. O’Neill, MB, BCh, DPhil; Stéphane Garrigue, MD, PhD; Bertrand Pierre, MD; Pierre Jaïs, MD; Jean-Luc Pasquié, MD, PhD; Mélèze Hocini, MD; Michèle Salvador-Mazenq, MD; Akihiko Nogami, MD; Alain Amiel, MD; Pascal Defaye, MD; Pierre Bordachar, MD; Serge Boveda, MD; Philippe Maury, MD; Didier Klug, MD, PhD; Dominique Babuty, MD, PhD; Michel Haïssaguerre, MD; Jacques Mansourati, MD; Jacques Clémenty, MD; Hervé Le Marec, MD, PhD

From the Université Bordeaux II, Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France (F.S., M.D.O., P. Jais, M. Hocini, P.B., M. Haïssaguerre, J.C.); Institut du thorax, CHU de Nantes, France (V.P., H.L.M.); Tsuchiura Kyodo Hospital, Japan (Y.I., Y.T.); CHU de Grenoble, France (P. Jacon, P.D.); CHU de Poitiers, France (J.L., A.A.); CHU de Lille, France (F.M.-G., D.K.); CHU de Rennes, France (P. Mabo); Hopital Saint André, Bordeaux, France (S.R.); CHU de Clermont-Ferrand, France (D.L.); Clinique Saint Augustin, Bordeaux, France (S.G.); CHU de Tours, France (B.P., D.B.); CHU de Montpellier, France (J.-L.P.); CHU de Toulouse, France (M.S.-M., P. Maury); Yokohama Rosai Hospital, Japan (A.N.); Clinique Pasteur, Toulouse, France (S.B.); and CHU de Brest, France (J.M.).

Correspondence to Dr Frédéric Sacher, Hôpital Cardiologique du Haut-Lévêque, 33604 Bordeaux-Pessac, France. E-mail frederic.sacher{at}chu-bordeaux.fr

Received March 22, 2006; revision received September 26, 2006; accepted September 29, 2006

Background— Brugada syndrome is an arrhythmogenic disease characterized by an increased risk of sudden cardiac death (SCD) by ventricular fibrillation. At present, an implantable cardioverter-defibrillator (ICD) is the recommended therapy in high-risk patients. This multicenter study reports the outcome of a large series of patients implanted with an ICD for Brugada syndrome.

Methods and Results— All patients (n=220, 46±12 years, 183 male) with a type 1 Brugada ECG pattern implanted with an ICD in 14 centers between 1993 and 2005 were investigated. ICD indication was based on resuscitated SCD (18 patients, 8%), syncope (88 patients, 40%), or positive electrophysiological study in asymptomatic patients (99 patients, 45%). The remaining 15 patients received an ICD because of a family history of SCD or nonsustained ventricular arrhythmia. During a mean follow-up of 38±27 months, no patient died and 18 patients (8%) had appropriate device therapy (10±15 shocks/patient, 26±33 months after implantation). The complication rate was 28%, including inappropriate shocks, which occurred in 45 patients (20%, 4±3 shocks/patient, 21±20 months after implantation). The reasons for inappropriate therapy were lead failure (19 patients), T-wave oversensing (10 patients), sinus tachycardia (10 patients), and supraventricular tachycardia (9 patients). Among implantation parameters, high defibrillation threshold, high pacing threshold, and low R-wave amplitude occurred, respectively, in 12%, 27%, and 15% of cases.

Conclusion— In this large Brugada syndrome population, a low incidence of arrhythmic events was found, with an annual event rate of 2.6% during a follow-up of >3 years, in addition to a significant risk of device-related complications (8.9%/year). Inappropriate shocks were 2.5 times more frequent than appropriate ones.

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