Aims Data on predictors of time-to-first appropriate implantable cardioverter-defibrillator (ICD) therapy in patients with Brugada Syndrome (BrS) and prophylactically implanted ICD’s are scarce. ................................................................................................................................................................................................... Methods and results SABRUS (Survey on Arrhythmic Events in BRUgada Syndrome) is an international survey on 678 BrS patients who ex- perienced arrhythmic event (AE) including 252 patients in whom AE occurred after prophylactic ICD implantation. Analysis was performed on time-to-first appropriate ICD discharge regarding patients’ characteristics. Multivariate lo- gistic regression models were utilized to identify which parameters predicted time to arrhythmia <_5 years. The me- dian time-to-first appropriate ICD therapy was 24.8±2.8months. A shorter time was observed in patients from Asian ethnicity (P<0.05), those with syncope (P=0.001), and those with Class IIa indication for ICD (P=0.001). A longer time was associated with a positive family history of sudden cardiac death (P < 0.05). Multivariate Cox regres- sion revealed shorter time-to-ICD therapy in patients with syncope [odds ratio (OR) 1.65, P = 0.001]. In 193 patients (76.6%), therapy was delivered during the first 5years. Factors associated with this time were syncope (OR 0.36, P=0.001), spontaneous Type 1 Brugada electrocardiogram (ECG) (OR 0.5, P<0.05), and Class IIa indication (OR 0.38, P < 0.01) as opposed to Class IIb (OR 2.41, P < 0.01). A near-significant trend for female gender was also noted (OR 0.13, P = 0.052). Two score models for prediction of <5 years to shock were built. ................................................................................................................................................................................................... Conclusion First appropriate therapy in BrS patients with prophylactic ICD’s occurred during the first 5years in 76.6% of patients. Syncope and spontaneous Type 1 Brugada ECG correlated with a shorter time to ICD therapy.
Time-to-first appropriate shock in patients implanted prophylactically with an implantable cardioverter-defibrillator: data from the Survey on Arrhythmic Events in BRUgada Syndrome (SABRUS)
Giustetto, Carla;Gaita, Fiorenzo;
2019-01-01
Abstract
Aims Data on predictors of time-to-first appropriate implantable cardioverter-defibrillator (ICD) therapy in patients with Brugada Syndrome (BrS) and prophylactically implanted ICD’s are scarce. ................................................................................................................................................................................................... Methods and results SABRUS (Survey on Arrhythmic Events in BRUgada Syndrome) is an international survey on 678 BrS patients who ex- perienced arrhythmic event (AE) including 252 patients in whom AE occurred after prophylactic ICD implantation. Analysis was performed on time-to-first appropriate ICD discharge regarding patients’ characteristics. Multivariate lo- gistic regression models were utilized to identify which parameters predicted time to arrhythmia <_5 years. The me- dian time-to-first appropriate ICD therapy was 24.8±2.8months. A shorter time was observed in patients from Asian ethnicity (P<0.05), those with syncope (P=0.001), and those with Class IIa indication for ICD (P=0.001). A longer time was associated with a positive family history of sudden cardiac death (P < 0.05). Multivariate Cox regres- sion revealed shorter time-to-ICD therapy in patients with syncope [odds ratio (OR) 1.65, P = 0.001]. In 193 patients (76.6%), therapy was delivered during the first 5years. Factors associated with this time were syncope (OR 0.36, P=0.001), spontaneous Type 1 Brugada electrocardiogram (ECG) (OR 0.5, P<0.05), and Class IIa indication (OR 0.38, P < 0.01) as opposed to Class IIb (OR 2.41, P < 0.01). A near-significant trend for female gender was also noted (OR 0.13, P = 0.052). Two score models for prediction of <5 years to shock were built. ................................................................................................................................................................................................... Conclusion First appropriate therapy in BrS patients with prophylactic ICD’s occurred during the first 5years in 76.6% of patients. Syncope and spontaneous Type 1 Brugada ECG correlated with a shorter time to ICD therapy.
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