背景:Brugada综合征(BrS)的风险分层仍存在争议,关于植入式心律转复除颤器(ICD)的建议尚不完善。这项研究的目的是评估患有ICD的BrS患者的长期预后。
结果:在2002年4月至2012年10月期间评估的55例连续BrS患者中,36例(平均年龄41.7±13.8岁;81.8%男性)接受了ICD植入。19例(52.8%)无症状,11人(30.6%)曾有晕厥病史(8人怀疑有心律失常原因),6人(16.7%)曾中止心源性猝死(SCD)。自发性1型心电图(ECG)模式出现在25例(69.4%)患者和电生理研究(EPS)中,26人(72.2%),22例(84.6%)为阳性。在平均74±40个月的随访期间(72%的病例>5年),7例(19.4%)患者有适当的电击(年度事件发生率2.8%).这些患者最常流产SCD(54.1%vs.6.9%;p=0.008)和非持续性室性心动过速(57.1%vs.10.3%;p=0.016)随访期间。自发性1型心电图,晕厥和积极的EPS与适当的电击没有显着相关。多变量分析显示,中止的SCD是适当电击的独立预测因子(HR8.07,95%CI1.58-41.2;p=0.012)。ROC曲线分析表明,中止的SCD对预测适当的电击具有中等的判别能力(AUC0.751),敏感性为57%,特异性为93%。就ICD相关并发症而言,8例(22.2%)患者在随访期间有不适当的电击,主要是由于窦性心动过速(5例);一名患者有铅感染,另一名有铅骨折。
结论:在患有ICD的BrS患者中,适当冲击的长期比率为2.8%/年。中止的SCD与适当电击的风险较高相关,而晕厥和自发性I型ECG模式不能预测该事件。
BACKGROUND: Risk stratification of Brugada syndrome (BrS) remains controversial and recommendations for an implantable cardioverter-defibrillator (ICD) are not well established. The objective of this study was to assess the long-term prognosis of BrS patients with an ICD.
RESULTS: Of 55 consecutive patients with BrS assessed between April 2002 and October 2012, 36 (mean age 41.7 ± 13.8 years; 81.8% male) underwent ICD implantation. Nineteen (52.8%) were asymptomatic, 11 (30.6%) had previous history of syncope (arrhythmic cause suspected in eight) and six (16.7%) had aborted sudden cardiac death (SCD). Spontaneous type 1 electrocardiographic (ECG) pattern was present in 25 (69.4%) patients and electrophysiological study (EPS), performed in 26 (72.2%), was positive in 22 (84.6%). During a mean follow-up of 74 ± 40 months (>5 years in 72% of cases), seven (19.4%) patients had appropriate shocks (annual event rate 2.8%). These patients most frequently had aborted SCD (54.1% vs. 6.9%; p=0.008) and nonsustained ventricular tachycardia (57.1% vs. 10.3%; p=0.016) during follow-up. Spontaneous type 1 ECG pattern, syncope and positive EPS were not significantly associated with appropriate shocks. Multivariate analysis revealed that aborted SCD was an independent predictor of appropriate shocks (HR 8.07, 95% CI 1.58-41.2; p=0.012). ROC curve analysis demonstrated that aborted SCD had moderate discriminatory power to predict appropriate shocks (AUC 0.751), with sensitivity of 57% and specificity of 93%. In terms of ICD-related complications, eight (22.2%) patients had inappropriate shocks during the follow-up period, mainly due to sinus tachycardia (five patients); one patient had lead infection and another had a lead fracture.
CONCLUSIONS: In this population of BrS patients with ICD, the long-term rate of appropriate shocks was 2.8%/year. Aborted SCD was associated with a higher risk of appropriate shocks, whereas syncope and spontaneous type I ECG pattern did not predict this event.