Rosso Raphael, Glick Aharon, Glikson Michael, Wagshal Abraham, Swissa Moshe, Rosenhek Shimon, Shetboun Israel, Khalamizer Vladimir, Fuchs Therese, Boulos Munther, Geist Michael, Strasberg Boris, Ilan Michael, Belhassen Bernard
Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Isr Med Assoc J. 2008 Jun;10(6):435-9.
Many electrophysiologists recommend implantable cardioverter defibrillators for patients with Brugada syndrome who are cardiac arrest survivors or presumed at high risk of sudden death (patients with syncope or a familial history of sudden death or those with inducible ventricular fibrillation at electrophysiologic study).
To assess the efficacy and complications of ICD therapy in patients with Brugada syndrome.
The indications, efficacy and complications of ICD therapy in all patients with Brugada syndrome who underwent ICD implantation in 12 Israeli centers between 1994 and 2007 were analyzed.
There were 59 patients (53 males, 89.8%) with a mean age of 44.1 years. At diagnosis 42 patients (71.2%) were symptomatic while 17 (28.8%) were asymptomatic. The indications for ICD implantation were: a history of cardiac arrest (n = 11, 18.6%), syncope (n = 31, 52.5%), inducible VF in asymptomatic patients (n = 14, 23.7%), and a family history of sudden death (n = 3, 0.5%). The overall inducibility rates of VF were 89.2% and 93.3% among the symptomatic and asymptomatic patients, respectively (P = NS). During a follow-up of 4-160 (45 +/- 35) months, all patients (except one who died from cancer) are alive. Five patients (8.4%), all with a history of cardiac arrest, had appropriate ICD discharge. Conversely, none of the patients without prior cardiac arrest had appropriate device therapy during a 39 +/- 30 month follow-up. Complications were encountered in 19 patients (32%). Inappropriate shocks occurred in 16 (27.1%) due to lead failure/dislodgment (n = 5), T wave oversensing (n = 2), device failure (n = 1), sinus tachycardia (n = 4), and supraventricular tachycardia (n = 4). One patient suffered a pneumothorax and another a brachial plexus injury during the implant procedure. One patient suffered a late (2 months) perforation of the right ventricle by the implanted lead. Eleven patients (18.6%) required a reintervention either for infection (n = 1) or lead problems (n = 10). Eight patients (13.5%) required psychiatric assistance due to complications related to the ICD (mostly inappropriate shocks in 7 patients).
In this Israeli population with Brugada syndrome treated with ICD, appropriate device therapy was limited to cardiac arrest survivors while none of the other patients including those with syncope and/or inducible VF suffered an arrhythmic event. The overall complication rate was high.
许多电生理学家建议为心脏骤停幸存者或推测有猝死高风险的Brugada综合征患者植入植入式心律转复除颤器（心脏骤停幸存者、有晕厥或猝死家族史者或在电生理检查中可诱发室颤者）。
评估ICD治疗Brugada综合征患者的疗效和并发症。
分析了1994年至2007年间在以色列12个中心接受ICD植入的所有Brugada综合征患者的ICD治疗指征、疗效和并发症。
共59例患者（53例男性，占89.8%），平均年龄44.1岁。诊断时，42例患者（71.2%）有症状，17例（28.8%）无症状。ICD植入的指征为：心脏骤停病史（n = 11，18.6%）、晕厥（n = 31，52.5%）、无症状患者可诱发室颤（n = 14，23.7%）和猝死家族史（n = 3，0.5%）。有症状和无症状患者中室颤的总体诱发率分别为89.2%和93.3%（P = 无显著差异）。在4至160（45±35）个月的随访期间，所有患者（除1例死于癌症）均存活。5例患者（8.4%）均有心脏骤停病史，ICD进行了适当放电。相反，在39±30个月的随访中，既往无心脏骤停的患者均未接受适当的器械治疗。19例患者（32%）出现并发症。16例（27.1%）发生不适当电击，原因包括导线故障/脱位（n = 5）、T波感知过度（n = 2）、器械故障（n = 1）、窦性心动过速（n = 4）和室上性心动过速（n = 4）。1例患者在植入过程中发生气胸，另1例发生臂丛神经损伤。1例患者植入导线后右心室出现晚期（2个月）穿孔。11例患者（18.6%）因感染（n = 1）或导线问题（n = 10）需要再次干预。8例患者（13.5%）因与ICD相关的并发症（7例主要为不适当电击）需要精神科协助。
在这一接受ICD治疗的以色列Brugada综合征患者群体中，适当的器械治疗仅限于心脏骤停幸存者，而其他患者，包括有晕厥和/或可诱发室颤的患者，均未发生心律失常事件。总体并发症发生率较高。
