SPC365

Usefulness of subcutaneous Implantable Loop Recorder in Brugada Syndrome: a single center experience.

Session: Sessão de Posters 28 - Morte súbita cardíaca
Speaker: MARIANA GOMES TINOCO

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: Mariana Tinoco; Margarida Castro; Luísa Pinheiro; Lucy Calvo; Silvia Ribeiro; Filipa Almeida; Filipa Cardoso; Bernardete Rodrigues; Claudia Mendes; Assunção Alves; Victor Sanfins; António Lourenço

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive"><strong>Introduction:</strong> Risk stratification in Brugada syndrome (BS) can be challenging. Useful variables in determining patient (P) risk include cardiogenic syncope and positive electrophysiological study (EPS) in spontaneous type 1 B pattern. Controversially, there is some evidence that a family history of sudden cardiac death and ECG markers may be predictors. </span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive"><strong>Purpose:</strong> To evaluate the importance of implantable loop recorder (ILR) in BSP risk stratification.</span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive"><strong>Methods:</strong> <span style="background-color:white"><span style="color:black">Single-center retrospective study of BSP who implanted an ILR between 2000 and 2023.</span></span> <span style="background-color:white"><span style="color:black">Demographic, clinical and follow-up data were analyzed.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive"><strong>Results:</strong> A total of 53 BSP were included (60% male, mean age of 51&plusmn;14 years). All P had undergone ECG, transthoracic echocardiogram, and 24-h Holter monitoring as part of the previous study. 29P (55%) had previously undergone an EPS and 7P (14%) had undergone tilt test. No complications related to the procedure were recorded.</span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive">Among this population, 45% (24P) underwent ILR implantation for syncope of uncertain etiology. Of these, 50% (12P) underwent an EPS prior to implantation, and 25% (6P) underwent a tilt test. Additionally, 42% (22P) underwent ILR implantation for palpitations, and 13% (7P) had ILR implantation for risk markers on EPS (low ventricular refractory period).</span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive">During a median follow-up of 31 (IQR 10-42) months, events were documented in 12P (22%); 4P with ILR for palpitations were diagnosed with supraventricular tachycardia (SVT), of which 3 were referred for an EPS. Another P had one episode of symptomatic atrial fibrillation (AF) that lasted for 11 hours. 2P who had ILR implanted for syncope had one episode of asymptomatic AF (43h and 10min). All 3P started anticoagulation therapy (CHA2DS2&ndash;VASc score of 2 in 1P and 3 in 2P).</span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive">Symptoms without diagnostic findings were reported in 3P (6%).</span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive">2P with syncope under investigation (uncertain clinical characteristics and negative previous EPS) were diagnosed with VT and an ICD was implanted. One patient recorded asymptomatic non-sustained ventricular tachycardia. </span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive">Another patient had episodes of nocturnal complete heart block<span style="background-color:white"><span style="color:black"> with subsequent sleep apnea diagnosis and started CPAP therapy. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive"><strong>Conclusion: </strong>Two P had an episode of VT when the previously performed EPS did not trigger any arrhythmia. This reveals the controversy regarding the prognostic applicability of EPS in BSP risk stratification. In practice, it was the ILR that allowed the documentation of the arrhythmic event, forcing us to reflect on the importance and usefulness of this device in risk stratification for these P.</span></span></p>