Atrial fibrillation in a large population with Brugada electrocardiographic pattern: prevalence, management, and correlation with prognosis

BACKGROUND A high prevalence of atrial fibrillation/atrial flutter(AF/AFl) has been reported in small series of Brugada patients, with discordant data. OBJECTIVE The purpose of this study was to analyze, in a large population of Brugada patients, the prevalence of AF/AFl, its correlation with prognosis, and the efficacy of hydroquinidine (HQ) treatment. METHODS Among 560 patients with Brugada type 1 ECG (BrECG), 48 (9%) had AF/AFl.Three groups were considered: 23 patients with BrECG pattern recognized before AF/AFl (group1); 25 patients first diagnosed with AF/AFl in whom Class IC anti arrhythmic drugs administered for cardioversion/prophylaxis unmasked BrECG (group2) and 512 patients without AF/AFl (group3). Recurrence of AF/AFl and occurrence of ventricular arrhythmias were evaluated at follow-up. RESULTS Mean age was 47 years, 59 years and44 years in groups 1,2 and3,respectively. Seven subjects (32%) in group 1had syncope/aborted sudden death,1 (4%) in group 2 and 122 (24%) in group 3.Ventricular arrhythmia occurred in three patients in group 1, none in group 2 and 10 in group 3 at median follow-up of 51, 68 and41months, respectively. Nine patients in group 1 and nine in group 2 received HQ for AF/AFl prophylaxis; on therapy, none had AF/AFl recurrence. CONCLUSION Prevalence ofAF/AFl in Brugada patients is higher than in the general population of the same age. Patients in group 1 are younger than those in group 2 and have a worse prognosis compared to both groups 2 and 3. HQ therapy has proved useful and safe in patients with AF/AFl and BrECG.