The role of clinical assessment and electrophysiology study in Brugada syndrome patients with syncope - 05/02/20
, Elena Arbelo, MD, PhD a, b, c, 1, Paloma Jorda, MD a, b, Roger Borras, MSc a, b, Oscar Campuzano, BSc, PhD c, d, e, Georgia Sarquella-Brugada, MD, PhD e, f, Anna Iglesias, PhD c, d, e, Lluis Mont, MD, PhD a, b, c, Ramon Brugada, MD, PhD c, d, e, g, Josep Brugada, MD, PhD a, b, c, fRésumé |
Background |
Cardiogenic syncope in Brugada syndrome (BrS) increases the risk of major events. Nevertheless, clinical differentiation between cardiogenic and vasovagal syncope can be challenging. We characterized the long-term incidence of major events in a large cohort of BrS patients who presented with syncope.
Methods |
From a total of 474 patients, syncope was the initial manifestation in 135 (28.5%) individuals (43.9 ± 13.9 years, 71.1% male). The syncope was classified prospectively as cardiogenic, vasovagal, or undefined if unclear characteristics were present. Clinical, electrocardiographic, genetic, and electrophysiologic features were analyzed. Cardiogenic syncope, sustained ventricular arrhythmias, and sudden death were considered major events in follow-up.
Results |
In 66 patients (48.9%), the syncope was cardiogenic; in 51 (37.8%), vasovagal and in 18 (13.3%); undefined. The electrophysiology study (EPS) inducibility was more frequent in patients with cardiogenic syncope and absent in all patients with undefined syncope (28 [53.8%] vs 5 [12.2%] vs 0 [0%]; P < .01). During follow-up (7.7 ± 5.6 years), only patients with cardiogenic syncope presented major events (16 [11.9%]). Among patients with inducible EPS, 7 (21.2%) presented major events (P = .04). The negative predictive value of the EPS for major events was 92.4%. The incidence rate of major events was 2.6% person-year. Parameters associated with major events included cardiogenic syncope (hazard ratio [HR] 6.3; 95% CI 1.1-10.4; P = .05), spontaneous type 1 electrocardiogram (HR 3.7; 95% CI 1.3-10.5; P = .01), and inducible EPS (HR 2.8; 95% CI 1.1-8.8; P = .05).
Conclusions |
An accurate syncope classification is crucial in BrS patients for risk stratification. In patients with syncope of unclear characteristics, the EPS may be helpful to prevent unnecessary implantable cardioverter defibrillators.
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| Funding: This work was supported by Instituto de Salud Carlos III (FIS PI16/01203 and PI17/01690) co-funded by the European Regional Development Fund and the European Social Found “Investing in Your Future,” The CERCA Programme (Centres de Recerca de Catalunya) of the Generalitat de Catalunya, Daniel Bravo Andreu Foundation, and Obra Social "La Caixa.". Disclosures: none. |
Vol 220
P. 213-223 - février 2020 Retour au numéro
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