Implantable Cardioverter-Defibrillator Therapy in Brugada Syndrome: A 30-Year Single-Center Experience (JCEP June 2025)-Article: Implantable Cardioverter-Defibrillator Therapy in Brugada Syndrome: A 30-Year Single-Center Experience

Article: Implantable Cardioverter-Defibrillator Therapy in Brugada Syndrome: A 30-Year Single-Center Experience

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This study explores a 30-year single-center experience with implantable cardioverter-defibrillator (ICD) therapy in Brugada Syndrome (BrS) patients. BrS is a condition that can lead to sudden cardiac death (SCD) due to ventricular arrhythmias, making ICD therapy critical for high-risk patients. However, risk stratification and the implementation of ICDs for primary prevention in asymptomatic patients remain debatable.<br /><br />The research involved 306 BrS-diagnosed patients (186 male, with a mean age of 41 years) who received ICDs between 1992 and 2022. ICDs were implanted for secondary prevention in 16% of these patients. Over the decades, risk factors fluctuated initially but stabilized in recent years, although device-related complications like inappropriate shocks and lead dysfunctions were frequent.<br /><br />The study found that 14% of the patients experienced sustained ventricular arrhythmia, while 15% had inappropriate ICD shocks. Revisions were necessary for 27% due to lead dysfunctions. Secondary prevention ICD recipients had a higher incidence of arrhythmias. Notably, thoracoscopic epicardial ablation reduced ventricular arrhythmias in high-risk patients who underwent the procedure.<br /><br />Overall mortality was low at 5.88%, with 22.2% of deaths cardiac-related. The study emphasizes the importance of individualized treatment strategies to optimize ICD therapy benefits while minimizing complications. It suggests that despite its crucial role in preventing fatal arrhythmias, ICD therapy comes with significant risks, highlighting the potential of adjunctive therapies like ablation to improve long-term outcomes.<br /><br />This extensive follow-up provides valuable insights into the evolving management of BrS and underscores the importance of long-term data in shaping clinical practices and guidelines, particularly regarding the balance between benefits and risks in ICD use.

Keywords

Brugada Syndrome

implantable cardioverter-defibrillator

ICD therapy

sudden cardiac death

ventricular arrhythmias

risk stratification

device complications

epicardial ablation

long-term outcomes

clinical guidelines