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Abstract：
OBJECTIVE: Available data on continuous rhythm monitoring by implantable loop recorders (ILRs) in patients with Brugada syndrome (BrS) are scarce. The aim of this multi-centre study was to evaluate the diagnostic yield and clinical implication of a continuous rhythm monitoring strategy by ILRs in a large cohort of BrS patients and to assess the precise arrhythmic cause of syncopal episodes.
METHODS: A total of 370 patients with BrS and ILRs (mean age 43.5 ± 15.9, 33.8% female, 74.1% symptomatic) from 18 international centers were included. Patients were followed with continuous rhythm monitoring for a median follow-up of 3 years.
RESULTS: During follow-up, an arrhythmic event was recorded in 30.7% of symptomatic patients [18.6% atrial arrhythmias (AAs), 10.2% bradyarrhythmias (BAs), and 7.3% ventricular arrhythmias (VAs)]. In patients with recurrent syncope, the aetiology was arrhythmic in 22.4% (59.3% BAs, 25.0% VAs, and 15.6% AAs). The ILR led to drug therapy initiation in 11.4%, ablation procedure in 10.9%, implantation of a pacemaker in 2.5%, and a cardioverter-defibrillator in 8%. At multivariate analysis, the presence of symptoms [hazard ratio (HR) 2.5, P = .001] and age >50 years (HR 1.7, P = .016) were independent predictors of arrhythmic events, while inducibility of ventricular fibrillation at the electrophysiological study (HR 9.0, P < .001) was a predictor of VAs.
CONCLUSIONS: ILR detects arrhythmic events in nearly 30% of symptomatic BrS patients, leading to appropriate therapy in 70% of them. The most commonly detected arrhythmias are AAs and BAs, while VAs are detected only in 7% of cases. Symptom status can be used to guide ILR implantation.
METHODS: A total of 370 patients with BrS and ILRs (mean age 43.5 ± 15.9, 33.8% female, 74.1% symptomatic) from 18 international centers were included. Patients were followed with continuous rhythm monitoring for a median follow-up of 3 years.
RESULTS: During follow-up, an arrhythmic event was recorded in 30.7% of symptomatic patients [18.6% atrial arrhythmias (AAs), 10.2% bradyarrhythmias (BAs), and 7.3% ventricular arrhythmias (VAs)]. In patients with recurrent syncope, the aetiology was arrhythmic in 22.4% (59.3% BAs, 25.0% VAs, and 15.6% AAs). The ILR led to drug therapy initiation in 11.4%, ablation procedure in 10.9%, implantation of a pacemaker in 2.5%, and a cardioverter-defibrillator in 8%. At multivariate analysis, the presence of symptoms [hazard ratio (HR) 2.5, P = .001] and age >50 years (HR 1.7, P = .016) were independent predictors of arrhythmic events, while inducibility of ventricular fibrillation at the electrophysiological study (HR 9.0, P < .001) was a predictor of VAs.
CONCLUSIONS: ILR detects arrhythmic events in nearly 30% of symptomatic BrS patients, leading to appropriate therapy in 70% of them. The most commonly detected arrhythmias are AAs and BAs, while VAs are detected only in 7% of cases. Symptom status can be used to guide ILR implantation.
摘要：
目的：在Brugada综合征（BrS）患者中通过植入式环路记录仪（ILR）进行连续节律监测的可用数据很少。这项多中心研究的目的是评估ILRs在大量BrS患者中的连续节律监测策略的诊断率和临床意义，并评估晕厥发作的准确心律失常原因。
方法：共有370例BrS和ILRs患者（平均年龄43.5±15.9，33.8%为女性，包括来自18个国际中心的74.1%有症状)。对患者进行连续节律监测，中位随访时间为3年。
结果：随访期间，有症状的患者有30.7%的心律失常事件[18.6%的房性心律失常(AAs),10.2％的缓慢性心律失常（BA），和7.3%室性心律失常(VA)]。在复发性晕厥患者中，病因为心律失常的22.4%(59.3%BA，25.0%VAs，和15.6%的AA）。ILR导致11.4%的药物治疗开始，消融手术占10.9%，植入起搏器的比例为2.5%，和8%的心脏复律除颤器。在多变量分析中，症状的存在[危险比(HR)2.5,P=.001]和年龄>50岁(HR1.7,P=.016)是心律失常事件的独立预测因子,而电生理研究中心室纤颤的诱导性（HR9.0，P<.001）是VAs的预测因子。
结论：ILR在近30%的有症状的BrS患者中检测到心律失常事件，导致70%的患者得到适当的治疗。最常见的心律失常是AA和BA，而仅在7%的病例中检测到VA。症状状态可用于指导ILR植入。
方法：共有370例BrS和ILRs患者（平均年龄43.5±15.9，33.8%为女性，包括来自18个国际中心的74.1%有症状)。对患者进行连续节律监测，中位随访时间为3年。
结果：随访期间，有症状的患者有30.7%的心律失常事件[18.6%的房性心律失常(AAs),10.2％的缓慢性心律失常（BA），和7.3%室性心律失常(VA)]。在复发性晕厥患者中，病因为心律失常的22.4%(59.3%BA，25.0%VAs，和15.6%的AA）。ILR导致11.4%的药物治疗开始，消融手术占10.9%，植入起搏器的比例为2.5%，和8%的心脏复律除颤器。在多变量分析中，症状的存在[危险比(HR)2.5,P=.001]和年龄>50岁(HR1.7,P=.016)是心律失常事件的独立预测因子,而电生理研究中心室纤颤的诱导性（HR9.0，P<.001）是VAs的预测因子。
结论：ILR在近30%的有症状的BrS患者中检测到心律失常事件，导致70%的患者得到适当的治疗。最常见的心律失常是AA和BA，而仅在7%的病例中检测到VA。症状状态可用于指导ILR植入。
