SPC365

Exercise stress test in Brugada Syndrome – should we restrict physical activity?

Session: Posters (Sessão 3 - Écran 4) - Morte súbita cardíaca
Speaker: ANGELA MARGARIDA MARTINS DE CASTRO

Congress: CPC 2023
Topic: C. Arrhythmias and Device Therapy
Theme: 08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme: 08.7 Ventricular Arrhythmias and SCD - Other
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Margarida De Castro; Filipa Cardoso; Tamara Pereira; Mariana Tinoco; Luísa Pinheiro; Margarida Oliveira; Bebiana Faria; Lucy Calvo; João Português; Sílvia Ribeiro; Victor Sanfins; António Lourenço

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><strong><span style="font-size:10.0pt">Introduction</span></strong><span style="font-size:10.0pt">: Brugada syndrome (BrS) increases the risk for ventricular arrhythmias (VA) and sudden cardiac death (SCD). Some triggers can result in the expression of higher-risk BrS type 1 pattern. They include fever, enhanced vagal tone and sodium channel blocking agents. There is scarce data on the risk of exercise training and the role of exercise stress test in these patients (pts). </span></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><strong><span style="font-size:10.0pt">Purpose</span></strong><span style="font-size:10.0pt">: We aim to describe the role of exercise stress testing in a BrS population. </span></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><strong><span style="font-size:10.0pt">Methods:</span></strong><span style="font-size:10.0pt"> Retrospective single-center study of pts with BrS diagnosed between January 2004 and September 2022 that underwent exercise stress test. </span></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><strong><span style="font-size:10.0pt">Results:</span></strong><span style="font-size:10pt"> We identified a total of 153 pts. The average age at diagnosis was 44</span><span style="font-size:10pt">&plusmn;</span><span style="font-size:10pt">13 years old&nbsp;(range 17-70) and 57,5% (n=88) were male. History of syncope was present in 34% (N=52) and agonic nocturnal breathing in 1.3% (N=2) of pts.</span><span style="font-size:10.6667px">&nbsp;</span><span style="font-size:10pt">Family history of BrS and/or SCD was present in 69,9% (N=107) of all cases. The diagnosis was made by provocative test with sodium channel blocking agents in 62,7% (N=96) and 24,8% (N=38) had spontaneous type 1 pattern. Regarding basal ECG, 26,8% (N=41) had a type 2 and 5,9% (N=9) type 3 pattern. SCN5A mutation was identified in 31,4% (N=48). </span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="font-size:10.0pt">The most frequent ECG change with exercise stress test was elevation of the J point observed in 53,6% (N=82), occurring more commonly during the early recovery phase.</span></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="font-size:10.0pt">Exercise stress test unmasked a typical coved-type 1 ECG pattern in 19,6% (N=30). </span></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="font-size:10.0pt">No VA were registered during stress testing.</span></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="font-size:10.0pt">During a mean follow-up (FU) of 31&plusmn;18 months, 29,4% (N=45) underwent electrophysiological study (EPS) and an implantable cardioverter-defibrillator was implanted in 16,3% (N=25) of which 2,6% (N=4) had appropriate shock for VA.</span></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="font-size:10.0pt">One patient (male, 35 years old, <em>index</em> case, without type 1 pattern on basal ECG), that recovered from cardiac arrest in the context of physical exercise, developed a typical coved-type 1 pattern during the peak effort of the exercise test, which maintained in the recovery phase. We are awaiting genetic test results. </span></span></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><strong><span style="font-size:10.0pt">Conclusions: </span></strong><span style="font-size:10.0pt">Despite the fact that exercise can worsen ST changes in BrS and enhance parasympathetic tone, increasing the theoretical risk of VA, our findings show that it is a safe and valuable tool for the evaluation of BrS. The unmasking of a typical pattern in exercise testing raises questions about the impact of physical exercise in this patient population. Its role to predict the risk for cardiac death requires larger studies and longer FU.</span></span></p>