Russo Vincenzo, Pafundi Pia Clara, Caturano Alfredo, Dendramis Gregory, Ghidini Andrea Ottonelli, Santobuono Vincenzo Ezio, Sciarra Luigi, Notarstefano Pasquale, Rucco Maria Antonietta, Attena Emilio, Floris Roberto, Romeo Emanuele, Sarubbi Berardo, Nigro Gerardo, D'Onofrio Antonio, Calò Leonardo, Nesti Martina
Department of Medical Translational Sciences, Division of Cardiology, Monaldi Hospital, University of Campania "Luigi Vanvitelli," Naples, Italy.
Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy.
JACC Clin Electrophysiol. 2021 Oct;7(10):1264-1273. doi: 10.1016/j.jacep.2021.03.010. Epub 2021 Apr 28.
This study aimed to retrospectively assess long-term outcome and the prognostic role of electrophysiological study (EPS) for risk stratification of drug-induced type 1 Brugada syndrome (BrS) patients.
BrS is a hereditary cardiac disease, predisposing to sudden cardiac death. Few real-world data are available on long-term outcomes of drug-induced type 1 BrS patients, and questions about risk stratification still remain unanswered.
The IBRYD (Italian Brugada Syndrome) study is a multicenter observational retrospective study. A total of 226 drug-induced type 1 BrS patients were enrolled from 9 Italian tertiary referral institutions. Primary endpoint was a composite of appropriate implantable cardioverter-defibrillator (ICD) therapy and sudden cardiac death. The authors further assessed clinical predictors to ICD implantation, as well as for arrhythmia induction at EPS, along with EPS as potential risk factor for the outcomes of interest.
142 patients (62.8%) received an ICD due to syncope and/or inducible ventricular tachyarrhythmias at EPS. During a median follow-up of 106 months, 11 patients (4.9%) experienced primary outcome events. The ICD therapy median annual incidence over 8 years was 0.38% (interquartile range: 0% to 1.47%). Ventricular tachyarrhythmia inducibility during EPS was not predictive of arrhythmic events in ICD recipients versus non-ICD patients and in symptomatic versus asymptomatic subgroups, showing a low positive predictive value (9.6% and 8.9%, respectively) versus a high negative predictive value (96.6% and 95%, respectively). The authors reported 29 ICD-related complications and 4.9% inappropriate shocks.
Drug-induced type 1 BrS patients have a very low arrhythmic risk. Clinical decision for implantation is supported by syncope and/or EPS positivity, though they fail to stratify high-risk patients. A better risk-to-benefit ratio should be pursued, considering both arrhythmic risk and ICD-related complications.
本研究旨在回顾性评估药物诱导的1型Brugada综合征（BrS）患者的长期预后以及电生理研究（EPS）在风险分层中的预后作用。
BrS是一种遗传性心脏病，易导致心源性猝死。关于药物诱导的1型BrS患者长期预后的真实世界数据很少，风险分层问题仍未得到解答。
IBRYD（意大利Brugada综合征）研究是一项多中心观察性回顾性研究。从9家意大利三级转诊机构招募了总共226例药物诱导的1型BrS患者。主要终点是适当的植入式心律转复除颤器（ICD）治疗和心源性猝死的复合终点。作者进一步评估了ICD植入的临床预测因素，以及EPS时心律失常的诱发情况，同时将EPS作为感兴趣结局的潜在风险因素。
142例患者（62.8%）因晕厥和/或EPS时可诱发室性快速心律失常而接受了ICD植入。在中位随访106个月期间，11例患者（4.9%）发生了主要结局事件。8年期间ICD治疗的年发病率中位数为0.38%（四分位间距：0%至1.47%）。EPS时室性快速心律失常的可诱发性在ICD植入患者与非ICD患者以及有症状与无症状亚组中均不能预测心律失常事件，显示出较低的阳性预测值（分别为9.6%和8.9%）与较高的阴性预测值（分别为96.6%和95%）。作者报告了29例与ICD相关的并发症和4.9%的不适当电击。
药物诱导的1型BrS患者心律失常风险非常低。晕厥和/或EPS阳性支持植入的临床决策，尽管它们无法对高危患者进行分层。应考虑心律失常风险和ICD相关并发症，追求更好的风险效益比。
