Brugada Syndrome and the Subcutaneous Implantable Cardioverter-Defibrillator

Nordkamp, Louise R.A. Olde; Conte, Giulio; Rosenmöller, Boudewijn R.A.M.; Warnaars, Joppe L.F.; Tan, Hanno L.; Caputo, Maria Luce; Regoli, François; Moccetti, Tiziano; Auricchio, Angelo; Knops, Reinoud E.; Wilde, Arthur A.M.

doi:10.1016/j.jacc.2016.05.058

Cited by 35 publications

(12 citation statements)

References 2 publications

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“…21 The overall S-ICD screening failure rate in the current ICD recipients was 13.8%, which was similar to previous reports. In contrast, failure in our patients with BrS in the left parasternal electrode positioning was 30%, which was comparable to that in a previous report during type 1 BrSECGs, 20 and considerably higher than in patients with other diseases requiring an ICD. However, in contrast to the previous reports, 20,21 the presentation of type 1 ECG was not related to the ineligibility of S-ICD in our BrS patients.…”

Section: Prevalence Of S-icd Unsuitabilitysupporting

confidence: 87%

Surface Electrocardiogram Screening for Subcutaneous Implantable Cardioverter-Defibrillators in Japanese Patients With and Without Brugada Syndrome

Kawabata

Goya

Sasaki

et al. 2017

Circ J

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Background: Subcutaneous implantable cardioverter-defibrillators (S-ICD) could eliminate lead-associated complications. We assessed the prevalence of S-ICD ineligibility in conventional ICD recipients and compared it in patients with and without Brugada syndrome (BrS). Methods and Results:Consecutive patients with a transvenous ICD without an indication for antibradycardia pacing were assessed. A patient was considered eligible for S-ICD if the ECG satisfied the screening template, both supine and standing, in ≥1 lead. Among 130 patients (103 men, age 57±15 years), a total of 18 (13.8%) patients were ineligible. The BrS group (n=33) had a significantly higher prevalence of S-ICD screening failure as compared with the non-BrS group (P=0.003; 30% vs. 8.2%). In the BrS group, the body mass index (BMI) was significantly lower, and T/QRS amplitude in lead I was significantly higher in those who were ineligible than that in the patients who were eligible. Of the 10 BrS patients failing the screening, 4 became eligible in the right parasternal electrode position. Conclusions:Among current ICD patients, there was a high incidence of patients with BrS who were unsuitable for S-ICD based on the left parasternal screening test. Suitability screening of patients for S-ICDs should be conducted carefully in patients with BrS, particularly if the BMI is low. Right parasternal electrode positioning should also be tested in such BrS patients.

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Section: Prevalence Of S-icd Unsuitabilitysupporting

confidence: 87%

Surface Electrocardiogram Screening for Subcutaneous Implantable Cardioverter-Defibrillators in Japanese Patients With and Without Brugada Syndrome

Kawabata

Goya

Sasaki

et al. 2017

Circ J

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“…The lower rate of device-related complications, together with a rare need for cardiac pacing in BrS, may make S-ICD a reasonable alternative in the ICD treatment of BrS. Cautious ECG assessment is crucial to qualifying eligible patients for this treatment and there are already reports of a high percentage of inappropriate sensing in BrS patients upon development of the type 1 ECG morphology [16,58].…”

Section: Implantable Cardioverter-defibrillator Placementmentioning

confidence: 99%

Brugada syndrome: new concepts and algorithms in management (RCD code: V 1A.1)

Matusik

Rydlewska

Pudło

et al. 2018

Journal of Rare Cardiovascular Diseases

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Clinical manifestation of Brugada syndrome (BrS) mainly results from polymorphic ventricular arrhythmias and includes sudden cardiac arrest (SCA). The Brugada sign, besides being present in true BrS, may result from different causes. Moreover, electrocardiogram findings in some clinical situations may resemble the BrS electrocardiographic pattern. Thus, differential diagnosis is crucial in the proper management of patients suspected of having BrS. Lifestyle modifications and close follow-up with or without pharmacologic treatment and/or implantable cardioverter-defibrillator placement constitute the most common approach to managing BrS patients. However, the role of ablation in BrS treatment is increasing. Due to diagnostic and therapeutic difficulties, the management of BrS is often challenging. This review provides new concepts and algorithms in the diagnostics and treatment of patients suspected of having BrS. JRCD 2017; 3 (5): 151-160

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“…Recently, the possibility of an entirely subcutaneous device (S-ICD) that avoids the side effects associated with transvenous electro-catheters has added options to the available armamentarium. 64 Such devices have recently overcome the initial concerns of a potential risk of undersensing tachyarrhythmias ( Figure 5B). To date, the role of the antitachypacing modality offered by traditional transvenous ICD in preventing degeneration of monomorphic VT is not considered essential in this category of patients, because low amplitude wave VF and polymorphic VT are the most common arrhythmias found in BrS patients; intriguingly, a recent multicenter retrospective study observed that monomorphic VTs account for only 4.2% of BrS patients implanted with an ICD and that there is a strong likelihood of arrhythmia disappearance after endocardial and/or epicardial ablation; 65 this technical aspect corroborates the therapeutic role of S-ICD, and its association with fewer complications over a lifetime qualifies the subcutaneous defibrillator as the present and future indication for this complex arrhythmogenic disease.…”

Section: Implantable Devicesmentioning

confidence: 99%

The Brugada Syndrome　― From Gene to Therapy ―

Curcio

Santarpia

Indolfi

2017

Circ J

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It is almost a quarter of century that a pioneering work of 2 researchers named Brugada brought the entire scientific community to understanding the molecular, clinical, and electrophysiological aspects of a distinctive syndrome. It affects mainly young adults with syncope and/or sudden cardiac death caused by polymorphic ventricular tachycardia or ventricular fibrillation in the absence of any sign of cardiac degeneration or alteration. Although the involvement of the epicardial layer of the right ventricular outflow tract, and the requirement of pharmacologic challenge for unveiling concealed forms, have been fully characterized, many areas of uncertainties remain to be elucidated, such as the unpredictable usefulness of programmed ventricular stimulation, the role of radiofrequency catheter ablation for reducing ST-segment elevation, and the value of risk stratification in patients diagnosed with upper displacement of right precordial leads. How much Brugada syndrome is an intense field of research is witnessed by 4 different consensus committees that took place in a relatively short period of time considering the recent discovery of this intricate arrhythmogenic disease. The main focus of this review is to describe the milestones in Brugada syndrome from its first phenotypic and genotypic appraisals to recent achievements in electrical therapies proposed for the management of this fascinating rhythm disturbance that, despite new diagnostic and therapeutic learnings, still predisposes to sudden cardiac death.

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Brugada Syndrome and the Subcutaneous Implantable Cardioverter-Defibrillator

Cited by 35 publications

References 2 publications

Surface Electrocardiogram Screening for Subcutaneous Implantable Cardioverter-Defibrillators in Japanese Patients With and Without Brugada Syndrome

Surface Electrocardiogram Screening for Subcutaneous Implantable Cardioverter-Defibrillators in Japanese Patients With and Without Brugada Syndrome

Brugada syndrome: new concepts and algorithms in management (RCD code: V 1A.1)

The Brugada Syndrome　― From Gene to Therapy ―

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Brugada Syndrome and the Subcutaneous Implantable Cardioverter-Defibrillator

Cited by 35 publications

References 2 publications

Surface Electrocardiogram Screening for Subcutaneous Implantable Cardioverter-Defibrillators in Japanese Patients With and Without Brugada Syndrome

Surface Electrocardiogram Screening for Subcutaneous Implantable Cardioverter-Defibrillators in Japanese Patients With and Without Brugada Syndrome

Brugada syndrome: new concepts and algorithms in management (RCD code: V 1A.1)

The Brugada Syndrome ― From Gene to Therapy ―

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The Brugada Syndrome　― From Gene to Therapy ―