Abstract：
BACKGROUND: Risk stratification in Brugada syndrome (BrS) remains controversial. In this respect, the role of the electrophysiology study (EPS) has been a subject of debate. In some centers, it is common practice to use an implantable loop recorder (ILR) after a negative EPS to help in risk stratification. However, the diagnostic value of this approach has never been specifically addressed.
OBJECTIVE: The aim of this study was to describe the baseline characteristics and the main findings of a diagnostic workup strategy with an ILR after a negative EPS in BrS.
METHODS: We conducted a retrospective international registry including patients with BrS and negative EPS (ie, noninducible ventricular tachycardia or ventricular fibrillation) before ILR monitoring.
RESULTS: The study included 65 patients from 8 referral hospitals in The Netherlands, Spain, and the United Kingdom (mean age, 39 ± 16 years; 72% male). The main indication for ILR monitoring was unexplained syncope/presyncope (66.2%). During a median follow-up of 39.0 months (Q1 25.0-Q3 47.6 months), 18 patients (27.7%) experienced 21 arrhythmic events (AEs). None of the patients died during follow-up. Bradyarrhythmias were the most common finding (47.6%), followed by atrial tachyarrhythmias (38.1%). Only 3 patients presented with ventricular arrhythmias. AEs were considered incidental in 12 patients (66.7%). In 11 patients (61.1%), AEs led to specific changes in treatment.
CONCLUSIONS: The use of ILR after a negative EPS in BrS is a safe strategy that reflected the high negative predictive value of EPS for ventricular arrhythmia in this syndrome. In addition, it allowed the detection of AEs in a significant proportion of patients, with therapeutic implications in most of them.
OBJECTIVE: The aim of this study was to describe the baseline characteristics and the main findings of a diagnostic workup strategy with an ILR after a negative EPS in BrS.
METHODS: We conducted a retrospective international registry including patients with BrS and negative EPS (ie, noninducible ventricular tachycardia or ventricular fibrillation) before ILR monitoring.
RESULTS: The study included 65 patients from 8 referral hospitals in The Netherlands, Spain, and the United Kingdom (mean age, 39 ± 16 years; 72% male). The main indication for ILR monitoring was unexplained syncope/presyncope (66.2%). During a median follow-up of 39.0 months (Q1 25.0-Q3 47.6 months), 18 patients (27.7%) experienced 21 arrhythmic events (AEs). None of the patients died during follow-up. Bradyarrhythmias were the most common finding (47.6%), followed by atrial tachyarrhythmias (38.1%). Only 3 patients presented with ventricular arrhythmias. AEs were considered incidental in 12 patients (66.7%). In 11 patients (61.1%), AEs led to specific changes in treatment.
CONCLUSIONS: The use of ILR after a negative EPS in BrS is a safe strategy that reflected the high negative predictive value of EPS for ventricular arrhythmia in this syndrome. In addition, it allowed the detection of AEs in a significant proportion of patients, with therapeutic implications in most of them.
摘要：
背景：Brugada综合征（BrS）的风险分层仍存在争议。在这方面,电生理学研究（EPS）的作用一直是争论的主题。在一些中心,通常的做法是在EPS阴性后使用植入式环路记录仪(ILR)来帮助进行风险分层.然而,这种方法的诊断价值从未得到具体解决.
目的：描述在BrS中EPS阴性后使用ILR进行诊断整理策略的基线特征和主要发现。
方法：我们进行了一项回顾性国际注册，其中包括BrS和EPS阴性的患者（即，非诱导型VT/VF)在ILR监测之前。
结果：来自荷兰8家转诊医院的65名患者，包括西班牙和英国(平均年龄39±16岁，72%男性）。ILR监测的主要指征是原因不明的晕厥/晕厥前(66.1%)。在39.0个月的中位随访期间（Q125.0-Q347.6），18例患者（27.7%）经历了21次心律失常事件（AE）。随访期间无一例患者死亡。缓慢性心律失常是最常见的发现（47.6％），其次是房性快速性心律失常(38.1%)。只有3例患者出现室性心律失常。12例患者(66.7%)被认为是偶然的不良事件。在11名患者（61.1%）中，AE导致治疗的特定变化。
结论：在BrS中EPS阴性后使用ILR是一种安全的策略，反映了EPS对该综合征室性心律失常的高阴性预测值。此外,它允许在相当比例的患者中检测到AE，其中大多数都有治疗意义。
目的：描述在BrS中EPS阴性后使用ILR进行诊断整理策略的基线特征和主要发现。
方法：我们进行了一项回顾性国际注册，其中包括BrS和EPS阴性的患者（即，非诱导型VT/VF)在ILR监测之前。
结果：来自荷兰8家转诊医院的65名患者，包括西班牙和英国(平均年龄39±16岁，72%男性）。ILR监测的主要指征是原因不明的晕厥/晕厥前(66.1%)。在39.0个月的中位随访期间（Q125.0-Q347.6），18例患者（27.7%）经历了21次心律失常事件（AE）。随访期间无一例患者死亡。缓慢性心律失常是最常见的发现（47.6％），其次是房性快速性心律失常(38.1%)。只有3例患者出现室性心律失常。12例患者(66.7%)被认为是偶然的不良事件。在11名患者（61.1%）中，AE导致治疗的特定变化。
结论：在BrS中EPS阴性后使用ILR是一种安全的策略，反映了EPS对该综合征室性心律失常的高阴性预测值。此外,它允许在相当比例的患者中检测到AE，其中大多数都有治疗意义。
