Abstract：
BACKGROUND: There are limited real-world data on the extended prognosis of patients with drug-induced type 1 Brugada electrocardiogram (ECG).
OBJECTIVE: We assessed the clinical outcomes and predictors of life-threatening arrhythmias in patients with drug-induced type 1 Brugada ECG.
METHODS: This multicenter retrospective study, conducted at 21 Italian and Swiss hospitals from July 1997 to May 2021, included consecutive patients with drug-induced type 1 ECG. The primary outcome, a composite of appropriate ICD therapies and sudden cardiac death, was assessed along with the clinical predictors of these events.
RESULTS: A total of 606 patients (mean age 49.7 ± 14.7 years; 423 [69.8%] men) were followed for a median of 60.3 months (interquartile range 23.0-122.4 months). Nineteen patients (3.1%) experienced life-threatening arrhythmias, with a median annual event rate of 0.5% over 5 years and 0.25% over 10 years. The SCN5A mutation was the only predictor of the primary outcome (hazard ratio 4.54; P = .002), whereas a trend was observed for unexplained syncope (hazard ratio 3.85; P = .05). In patients who were asymptomatic at presentation, the median annual rate of life-threatening arrhythmias is 0.24% over 5 years and increases to 1.2% if they have inducible ventricular fibrillation during programmed ventricular stimulation.
CONCLUSIONS: In patients with drug-induced type 1 Brugada ECG, the annual risk of life-threatening arrhythmias is low, with the SCN5A mutation as the only independent predictor. Unexplained syncope correlated with worse clinical outcomes. Ventricular fibrillation inducibility at programmed ventricular stimulation significantly increases the median annual rate of life-threatening arrhythmias from 0.24% to 1.2% over 5 years.
OBJECTIVE: We assessed the clinical outcomes and predictors of life-threatening arrhythmias in patients with drug-induced type 1 Brugada ECG.
METHODS: This multicenter retrospective study, conducted at 21 Italian and Swiss hospitals from July 1997 to May 2021, included consecutive patients with drug-induced type 1 ECG. The primary outcome, a composite of appropriate ICD therapies and sudden cardiac death, was assessed along with the clinical predictors of these events.
RESULTS: A total of 606 patients (mean age 49.7 ± 14.7 years; 423 [69.8%] men) were followed for a median of 60.3 months (interquartile range 23.0-122.4 months). Nineteen patients (3.1%) experienced life-threatening arrhythmias, with a median annual event rate of 0.5% over 5 years and 0.25% over 10 years. The SCN5A mutation was the only predictor of the primary outcome (hazard ratio 4.54; P = .002), whereas a trend was observed for unexplained syncope (hazard ratio 3.85; P = .05). In patients who were asymptomatic at presentation, the median annual rate of life-threatening arrhythmias is 0.24% over 5 years and increases to 1.2% if they have inducible ventricular fibrillation during programmed ventricular stimulation.
CONCLUSIONS: In patients with drug-induced type 1 Brugada ECG, the annual risk of life-threatening arrhythmias is low, with the SCN5A mutation as the only independent predictor. Unexplained syncope correlated with worse clinical outcomes. Ventricular fibrillation inducibility at programmed ventricular stimulation significantly increases the median annual rate of life-threatening arrhythmias from 0.24% to 1.2% over 5 years.
摘要：
背景：关于药物诱导的1型Brugada心电图（ECG）患者的长期预后的实际数据有限。
目的：我们评估了药物诱导的1型Brugada心电图患者发生危及生命的心律失常的临床结果和预测因素。
方法：这项多中心回顾性研究，从1997年7月至2021年5月在意大利和瑞士的21家医院进行,纳入了连续的药物诱导1型心电图患者.主要结果，适当的ICD治疗和心脏猝死（SCD）的组合，与这些事件的临床预测因素一起进行评估。
结果：总共606例患者（平均年龄49.7±14.7岁；69.8％为男性）获得了中位60.3[23.0-122.4]个月的随访。19例(3.1%)患者出现危及生命的心律失常,5年内的年事件发生率中位数为0.5%，10年内为0.25%。SCN5A突变是主要结局的唯一预测因子（HR：4.54，p=0.002）；而无法解释的晕厥有趋势（HR：3.85；p=0.05）。在就诊时无症状的患者中，在5年内,危及生命的心律失常的年中位值为0.24%,如果在程序性心室刺激(PVS)期间发生诱导性心室纤颤(VF),则年中位值为1.2%.
结论：在药物诱导的1型Brugada心电图患者中，每年发生危及生命的心律失常的风险很低,SCN5A突变是唯一的独立预测因子。原因不明的晕厥与较差的临床结果相关。在5年内，PVS的VF诱导性显着增加了威胁生命的心律失常的年中位数，从0.24％增加到1.2％。
目的：我们评估了药物诱导的1型Brugada心电图患者发生危及生命的心律失常的临床结果和预测因素。
方法：这项多中心回顾性研究，从1997年7月至2021年5月在意大利和瑞士的21家医院进行,纳入了连续的药物诱导1型心电图患者.主要结果，适当的ICD治疗和心脏猝死（SCD）的组合，与这些事件的临床预测因素一起进行评估。
结果：总共606例患者（平均年龄49.7±14.7岁；69.8％为男性）获得了中位60.3[23.0-122.4]个月的随访。19例(3.1%)患者出现危及生命的心律失常,5年内的年事件发生率中位数为0.5%，10年内为0.25%。SCN5A突变是主要结局的唯一预测因子（HR：4.54，p=0.002）；而无法解释的晕厥有趋势（HR：3.85；p=0.05）。在就诊时无症状的患者中，在5年内,危及生命的心律失常的年中位值为0.24%,如果在程序性心室刺激(PVS)期间发生诱导性心室纤颤(VF),则年中位值为1.2%.
结论：在药物诱导的1型Brugada心电图患者中，每年发生危及生命的心律失常的风险很低,SCN5A突变是唯一的独立预测因子。原因不明的晕厥与较差的临床结果相关。在5年内，PVS的VF诱导性显着增加了威胁生命的心律失常的年中位数，从0.24％增加到1.2％。
