Researchers analyze long-term benefit, safety of ICDs in patients with Brugada syndrome

Patients with Brugada syndrome (BrS) benefit from implantable cardioverter defibrillators (ICDs) but are at significant risk of device-related complications, according to the longest-term study to date on the topic.

Among 370 patients diagnosed with BrS at a single center, 104 were treated with ICDs. Researchers followed these individuals for a median of 9.3 years and published the results in the Journal of the American College of Cardiology.

Among their key findings:

• 21 patients experienced a total of 81 appropriate shocks, an incidence rate of 2.2 per 100 person-years.
• Patients who received an ICD for secondary prevention following resuscitated cardiac arrest or sustained ventricular arrhythmia were seven times more likely to experience an appropriate shock.
• Of 45 patients who were asymptomatic at diagnosis, four (8.9 percent) received appropriate ICD therapy during follow-up. All four had a spontaneous type 1 electrocardiogram and inducible ventricular arrhythmias.
• Nine patients experienced 37 inappropriate shocks, a rate of 0.9 per 100 person-years.
• 20 percent of patients experienced other ICD-related complications.
• One person died after an electrical storm during a lead extraction procedure.

The researchers pointed out Brugada syndrome (BrS) is often diagnosed in young, otherwise healthy individuals with a greater life expectancy than other conditions. Because ICDs are typically used for a longer period in this patient population, there is greater risk for device complications.

“Special care during ICD implantation, adequate device programming, and regular follow-up in a specialized cardiogenetic unit may allow reducing the number of adverse events,” wrote lead researcher Jaime Hernandez-Ojeda, MD, PhD, and colleagues.