Delise Pietro, Allocca Giuseppe, Sitta Nadir
Division of Cardiology, Clinica Pederzoli, Peschiera SG, 37019 Verona, Italy.
Division of Cardiology, Hospital of Conegliano, 31015 Treviso, Italy.
World J Cardiol. 2017 Sep 26;9(9):737-741. doi: 10.4330/wjc.v9.i9.737.
Patients with a Brugada type 1 electrocardiogram (ECG) pattern may suffer sudden cardiac death (SCD). Recognized risk factors are spontaneous type 1 ECG and syncope of presumed arrhythmic origin. Familial sudden cardiac death (f-SCD) is not a recognized independent risk factor. Finally, positive electrophysiologic study (+EPS) has a controversial prognostic value. Current ESC guidelines recommend implantable cardioverter defibrillator (ICD) implantation in patients with a Brugada type 1 ECG pattern if they have suffered a previous resuscitated cardiac arrest (class I recommendation) or if they have syncope of presumed cardiac origin (class IIa recommendation). In clinical practice, however, many other patients undergo ICD implantation despite the suggestions of the guidelines. In a 2014 cumulative analysis of the largest available studies (including over 2000 patients), we found that 1/3 of patients received an ICD in primary prevention. Interestingly, 55% of these latter were asymptomatic, while 80% had a + EPS. This means that over 30% of subjects with a Brugada type 1 ECG pattern were considered at high risk of SCD mainly on the basis of EPS, to which a class IIb indication for ICD is assigned by the current ESC guidelines. Follow-up data confirm that in clinical practice single, and often frail, risk factors overestimate the real risk in subjects with the Brugada type 1 ECG pattern. We can argue that, in clinical practice, many cardiology centers adopt an aggressive treatment in subjects with a Brugada type 1 ECG pattern who are not at high risk. As a result, many healthy persons may be treated in order to save a few patients with a true Brugada Syndrome. Better risk stratification is needed. A multi-parametric approach that considers the contemporary presence of multiple risk factors is a promising one.
具有1型Brugada心电图（ECG）模式的患者可能会发生心源性猝死（SCD）。已确认的危险因素是自发的1型ECG和推测为心律失常起源的晕厥。家族性心源性猝死（f-SCD）不是一个已确认的独立危险因素。最后，阳性电生理检查（+EPS）的预后价值存在争议。当前的欧洲心脏病学会（ESC）指南建议，对于具有1型Brugada ECG模式的患者，如果他们曾经历过心脏骤停复苏（I类推荐）或有推测为心脏起源的晕厥（IIa类推荐），应植入植入式心律转复除颤器（ICD）。然而，在临床实践中，尽管有指南建议，许多其他患者仍接受了ICD植入。在2014年对现有最大规模研究（包括2000多名患者）的累积分析中，我们发现三分之一的患者在一级预防中接受了ICD植入。有趣的是，其中55%的患者无症状，而80%的患者有+EPS。这意味着超过30%具有1型Brugada ECG模式的受试者主要基于EPS被认为有SCD的高风险，而当前ESC指南为ICD指定的IIb类适应症就是基于此。随访数据证实，在临床实践中，单一且往往较为脆弱的危险因素高估了具有1型Brugada ECG模式受试者的实际风险。我们可以说，在临床实践中，许多心脏病中心对并非高风险的具有1型Brugada ECG模式的受试者采取了积极的治疗措施。结果，为了挽救少数真正患有Brugada综合征的患者，许多健康人可能会接受治疗。需要更好的风险分层。一种考虑多种危险因素同时存在的多参数方法是很有前景的。
