Dores Hélder, Reis Santos Katya, Adragão Pedro, Moscoso Costa Francisco, Galvão Santos Pedro, Carmo Pedro, Cavaco Diogo, Bello Morgado Francisco, Mendes Miguel
Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal.
Centro Cardiovascular, Hospital da Luz, Lisboa, Portugal.
Rev Port Cardiol. 2015 Jun;34(6):395-402. doi: 10.1016/j.repc.2014.12.006. Epub 2015 May 29.
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.
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.
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.
Brugada综合征（BrS）的危险分层仍存在争议，对于植入式心脏复律除颤器（ICD）的建议也尚未明确确立。本研究的目的是评估植入ICD的BrS患者的长期预后。
在2002年4月至2012年10月期间连续评估的55例BrS患者中，36例（平均年龄41.7±13.8岁；81.8%为男性）接受了ICD植入。19例（52.8%）无症状，11例（30.6%）有晕厥病史（8例怀疑为心律失常所致），6例（16.7%）有心脏性猝死（SCD）未遂。25例（69.4%）患者存在自发1型心电图（ECG）模式，26例（72.2%）进行了电生理检查（EPS），其中22例（84.6%）为阳性。在平均74±40个月的随访期间（72%的病例超过5年），7例（19.4%）患者接受了恰当电击（年发生率2.8%）。这些患者在随访期间最常出现SCD未遂（54.1%对6.9%；p=0.008）和非持续性室性心动过速（57.1%对10.3%；p=0.016）。自发1型ECG模式、晕厥和EPS阳性与恰当电击无显著相关性。多因素分析显示，SCD未遂是恰当电击的独立预测因素（HR 8.07，95%CI 1.58 - 41.2；p=0.012）。ROC曲线分析表明，SCD未遂对预测恰当电击具有中等判别能力（AUC 0.751），敏感性为57%，特异性为93%。在ICD相关并发症方面，8例（22.2%）患者在随访期间接受了不恰当电击，主要原因是窦性心动过速（5例患者）；1例患者发生导线感染，另1例患者导线断裂。
在这群植入ICD的BrS患者中，恰当电击的长期发生率为每年2.8%。SCD未遂与更高的恰当电击风险相关，而晕厥和自发1型ECG模式并不能预测这一事件。
