Cardiology Department, Ospedale San Francesco, Nuoro, Italy.
Biomedical Science PhD Course, University of Sassari, Sassari, Italy.
J Cardiovasc Electrophysiol. 2021 Jun;32(6):1704-1711. doi: 10.1111/jce.15059. Epub 2021 May 5.
Subcutaneous implantable cardioverter defibrillators (S-ICDs) avoid complications secondary to transvenous leads, but inappropriate shocks (ISs) are frequent. Furthermore, IS data from patients with Brugada syndrome (BrS) with an S-ICD are scarce.
We aimed to establish the frequency and predictors of IS in this population.
We analyzed the clinical and electrocardiographic characteristics, automated screening test data, device programming, and IS occurrence in adult patients with BrS with an S-ICD.
Thirty-nine patients were enrolled (69% male, mean age at diagnosis 46 ± 13 years, mean age at implantation 48 ± 13 years). During a mean follow-up of 26 ± 21 months, 18% patients experienced IS. Patients with IS were younger at the time of diagnosis (36 ± 8 vs. 48 ± 13 years, p = .018) and S-ICD implantation (38 ± 9 vs. 50 ± 23 years, p = .019) and presented with spontaneous type 1 Brugada electrocardiogram pattern more frequently at diagnosis or during follow-up (71% vs. 25%, p = .018). During automated screening tests, patients with IS showed lower QRS voltage in the primary vector in the supine position (0.58 ± 0.26 vs. 1.10 ± 0.35 mV, p = .011) and lower defibrillator automated screening score in the primary vector in the supine (123 ± 165 vs. 554 ± 390 mV, p = .005) and standing (162 ± 179 vs. 486 ± 388 mV, p = .038) positions. Age at diagnosis was the only independent predictor of IS (hazard ratio = 0.873, 95% confidence interval: 0.767-0.992, p = .037).
IS was a frequent complication in patients with BrS with an S-ICD. Younger age was independently associated with IS. A more thorough screening process might help prevent IS in this population.
皮下植入式心律转复除颤器（S-ICD）可避免经静脉导联引起的并发症，但不恰当电击（IS）较为常见。此外，S-ICD 用于 Brugada 综合征（BrS）患者时的 IS 数据十分有限。
本研究旨在确定该人群中 IS 的发生频率和预测因素。
我们分析了 S-ICD 植入的 BrS 成年患者的临床和心电图特征、自动筛查试验数据、设备编程和 IS 发生情况。
共纳入 39 例患者（69%为男性，诊断时的平均年龄为 46±13 岁，植入时的平均年龄为 48±13 岁）。在平均 26±21 个月的随访期间，18%的患者发生了 IS。发生 IS 的患者诊断时年龄较小（36±8 岁 vs. 48±13 岁，p=0.018）和植入 S-ICD 时年龄较小（38±9 岁 vs. 50±23 岁，p=0.019），且更常出现自发性 1 型 Brugada 心电图模式（71% vs. 25%，p=0.018）。在自动筛查试验中，发生 IS 的患者在仰卧位时的主向量 QRS 电压较低（0.58±0.26 与 1.10±0.35 mV，p=0.011），仰卧位和站立位时的主向量自动筛查评分较低（123±165 与 554±390 mV，p=0.005；162±179 与 486±388 mV，p=0.038）。诊断时的年龄是 IS 的唯一独立预测因素（风险比=0.873，95%置信区间：0.767-0.992，p=0.037）。
IS 是 BrS 患者植入 S-ICD 后的常见并发症。年龄较小与 IS 独立相关。更全面的筛查过程可能有助于预防该人群的 IS。
