Background: Brugada syndrome (BrS) continues to pose clinical complexities, despite three decades of research. The pivotal role of implantable cardioverter-defibrillator (ICD) therapy in safeguarding high-risk patients from sudden cardiac death is undeniable. However, the debate on their use for primary prevention remains ongoing.
Objectives: This study aimed to evaluate the clinical features, management, and long-term outcomes of ICD therapy in patients with BrS.
Methods: BrS-diagnosed patients were prospectively enrolled. Inclusion criteria were: 1) a Brugada type 1 ECG pattern, spontaneous or drug induced, 2) ICD implantation, and 3) consistent follow-up. Risk stratification was based on prior VAs, and the multiparametric Brussel risk score was used from 2017. High-risk patients underwent video-thoracoscopic epicardial ablation starting in 2016.
Results: A total of 306 consecutive Brugada patients (186 male [61%]; mean age 41±17 years; range: 1-82 years) received ICDs from 1992 to 2022. ICDs were implanted for secondary prevention in 16% of patients. During long-term follow-up (mean 113.7 months), 14% of patients experienced a sustained VAs, 15% had inappropriate ICD shock-unaffected by the presence of single or dual leads-and 27% required device revision. Secondary prevention ICD patients had a higher incidence of both ventricular and supraventricular arrhythmias. Loss-of-function mutations and a prior non-sustained VA were associated to sustained VAs. Among high-risk patients, those who underwent epicardial ablation experienced significantly fewer VAs.
Conclusion: This 30-year study highlights ICD therapy's critical role in preventing VAs in BrS but also reveals frequent device-related complications. These findings emphasize the need for individualized treatment strategies to balance the risks/benefits of ICDs.
Editor-in-Chief
Kalyanam Shivkumar, MD, PhD, FACC
CME Editor
Kenneth A. Ellenbogen, MD, FACC
Author
Mahmoud Houmsse, MD, FACC
Important Dates
Date of Release: June 23, 2025
Term of Approval/Date of CME/MOC Expiration: June 22, 2026