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Curso de Atualização em Medicina Cardiovascular 2019
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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Does transvenous ICD leads increment the risk of ventricular arrhythmias in Brugada Syndrome patients when compared to subcutaneous ICDs?
Session:
Posters 5 - Écran 4 - Arritmologia
Speaker:
Dinis Mesquita
Congress:
CPC 2019
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.2 Ventricular Arrhythmias and SCD - Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Dinis Valbom Mesquita; Leonor Parreira; Pedro Lopes Do Carmo; Rita Marinheiro; Pedro Campos Amador; Diogo Cavaco; Elisabete Vaz; José Maria Farinha; Francisco Bello Morgado; Francisco Moscoso Costa; Pedro Adragão
Abstract
<p><strong>Introduction</strong>: Brugada Syndrome (BS) is a channelopathy which predisposes patients to sustained ventricular arrhythmias (VA) and sudden death. Implantable cardio-defibrillators (ICDs) are offered to survivors of aborted sudden death and to high risk patients in primary prevention.</p> <p><strong>Purpose</strong>: To understand if the use of a transvenous ICD lead is associated with an increased risk of sustained VA and ICD shocks due to mechanical induced ventricular ectopic beats following implant.</p> <p><strong>Methods</strong>: We analyzed a population of BS patients with ICD implanted in three hospital centers. Patients had ICD implanted either for secondary prevention (aborted arrhythmic sudden death) or for primary prevention (syncope and spontaneous or induced type 1 ECG pattern or a positive electrophysiologic study (EPS) in asymptomatic type 1 ECG pattern patients). We compared the incidence of VA and appropriate shocks in patients with transvenous ICD (group A) and sICD (group B) during follow up.</p> <p><strong>Results</strong>: In a cohort of 33 patients (81.8% male) with a mean age of 49.7 (IQR 42-59), 28 patients (84.8%) had ICD implant for primary prevention. Symptoms (syncope) were documented in 17 patients (51.5%), type 1 spontaneous ECG pattern in 30 (90.9%) and an EPS was performed and positive in 19 (57.6%). Nine patients (27.2%) had non sustained VA on device interrogation, one patient had an arrhythmic storm and 2 patients had epicardial right outflow tract ablation. There were no significant differences between baseline group characteristics except for follow up duration (89.6; IQR 15.2-108.4 months in group A and 22; IQR 12.6-54.5 months in group B; p=0.0007). During a mean follow up of 62.4 (IQR 15.3-105.8) months, appropriate shocks occurred in 7 patients (21.2%) of transvenous ICD group (and none in the sICD group). Kaplan-Meier estimates of the probability of survival free of ICD shocks was higher in sICD group (log Rank z=2.33; p=0.02) (See figure). The mean time for the first ICD therapy was 52.4 (IQR 29.1-74.1) months.</p> <p><strong>Conclusions</strong>: In this group of BS patients with ICD implanted for primary or secondary prevention, there was a long latency time for the first ICD therapy (52 months). There was no evidence that the implant of a transvenous ICD lead could precipitate sustained VA in Brugada patients following implant.</p>
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