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Role of Programmed Ventricular Stimulation in risk stratification of type 1 asymptomatic Brugada patients
Session:
Sessão de Posters 28 - Morte súbita cardíaca
Speaker:
Diogo De Almeida Fernandes
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.4 Ventricular Arrhythmias and SCD - Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Diogo De Almeida Fernandes; João Sanfins; Vanda Neto; Gonçalo Costa; Sílvia Ribeiro; Luís Santos; Natália António; Nuno Cortez Dias; Victor Sanfins; João de Sousa; Luís Elvas; Lino Gonçalves
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>INTRODUCTION</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The role of programmed ventricular stimulation (PVS) in identifying Brugada syndrome patients who are most at risk of sudden death remains controversial. Our aim was to assess outcomes in patients with asymptomatic spontaneous type 1 Brugada syndrome who underwent PVS.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>METHODS</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Multi-centre retrospective study including all patients with Brugada syndrome with a spontaneous type 1 pattern on the electrocardiogram (ECG) who underwent PVS. Patients with a follow-up time shorter than 1 year post-PVS were excluded and it was considered positive if arrhythmias or if the ventricular effective refractory period (VERP) inferior to 200ms. The primary outcome was defined as any cardiovascular event (CVe). Clinical and procedural data, as well as ICD implantation were recorded. </span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>RESULTS</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">118 patients from 4 centres were included, with a median follow-up time post PVS of 58 months (interquartile range [IQR] 39). The mean age at PVS was 49.7±12.5 years and 72.9% were male. Most patients had no history of syncope (73.4%) and were diagnosed following a routine ECG (61.2%). 19.6% of patients had a history of sudden death in a 1<sup>st</sup> degree relative and only 16.7% had a family history of Brugada syndrome. 84.3% of patients underwent genetic testing, 37.2% had a pathogenic mutation and 4.7% had a probable pathogenic mutation. Fragmented QRS complexes were found in 24.3% of cases, aVR sign in 40% and large S wave in lead I in 33.3%.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Regarding PVS, extrastimuli were delivered at the right ventricular (RV) apex in 55.4% of patients and in both the RV apex and outflow tract in 42.9%. Most patients underwent a protocol with 3 extrastimuli (75%). Arrhythmias were induced in 39.1% of cases and a VERP inferior to 200ms was present in 14.5%. ICD was implanted in 46.2% of patients (85.7% with positive PVS). CVe occurred in 11.5% with positive PVS (vs 8.2%, p 0.688).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The primary outcome occurred in 11 patients (9.3%) and polymorphic ventricular tachycardia was the most frequent CVe (27%). Sudden death occurred in 1 patient with negative PVS. Family history of sudden death was the only marker significantly increased in patients with CVe (54.5% vs 45.5%, p 0.028). After adjusting for relevant variables, a positive PVS was not linked to CVe (p 0.448).</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>CONCLUSION</strong></span></span></p> <p><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">PVS failed in identifying high-risk patients with spontaneous type 1 Brugada syndrome. These results may have been negatively influenced by the low number of events.</span></span></p>
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