TORNA ALL’ELENCO

Prognostic stratification of the subjects with Brugada electrocardiogram: the role of programmed electrical stimulation with 2 and 3 extrastimuli in European Heart Journal

2010
ASL Torino 3
ASL Vercelli

Tipo pubblicazione

Conference Abstract

Autori/Collaboratori (10)Vedi tutti...

Cerrato N
Cardinal Massaia Hospital, Department of Cardiology, Asti, Italy
Giustetto C
Cardinal Massaia Hospital, Department of Cardiology, Asti, Italy
Mazzanti A
Cardinal Massaia Hospital, Department of Cardiology, Asti, Italy

et alii...

Abstract

Purpose: Brugada syndrome is an arrhythmogenic disease characterized by an increased risk of sudden cardiac death (SCD). Until now, an implantable cardioverter defibrillator (ICD) is the only proven therapy. Therefore, it is mandatory to identify the subjects at high risk of SCD. The aim of the study was to evaluate the prognostic value of clinical and genetic variables (gender, family history, ECG features, symptoms, SCN5A mutation) and the role of programmed electrical stimulation (PES) in the risk stratification of the subjects with a Brugada ECG, comparing the predictive value of 2 different stimulation protocols, with 2 and 3 extrastimuli. Methods: 286 patients with spontaneous or drug-induced type 1 Brugada ECG were enrolled in 2 regions of Italy. PES was performed in 77% of them: 94 patients underwent a protocol with up to 2 extrastimuli until refractoriness, while 127 patients were studied up to the third extrastimulus. In both cases extrastimuli were delivered from two ventricular sites. Results: Population features at diagnosis: mean age 44±14 years; 49% spontaneous type 1 ECG; 64% asymptomatic individuals, 34% with history of syncope, 2% with aborted sudden death. Ventricular fibrillation (VF) was induced in 39% of patients studied with up to 2 extrastimuli and in 40% of those studied with up to 3 extrastimuli. During a follow-up of 38±28 months the incidence of arrhythmic events was 1.6% per year (3%-year in symptomatic patients vs 0.6%-year in asymptomatic ones). Induction of VF at PES (p=0.001), syncope (p=0.019) and spontaneous type 1 ECG (p=0.03) were predictors of arrhythmic events at followup. None of the patients with syncope and negative PES had events during followup. At PES, both protocols revealed high negative predictive value and sensitivity, with higher positive predictive value and specificity in the protocol with up to 2 extrastimuli [2 extrastimuli: sensitivity 100% (CI=59.0-100); NPV 100% (CI=93.7- 100); PPV 19% (CI=8-35.2); sp

DOI : 10.1093/eurheartj/ehq287

Keywords

electrocardiogram; stratification; society; electrostimulation; cardiology; patient; faintness; follow up; risk; sudden death; heart ventricle fibrillation; Brugada syndrome; defibrillator; therapy; gender; family history; mutation; stimulation; Italy; population; diagnosis;