Lights and shadows of subcutaneous implantable cardioverter-defibrillator in Brugada syndrome

Sixty years of the Bruce protocol: reappraising the contemporary role of exercise stress testing with electrocardiographic monitoring

“… 17 , 26 , 33 , 37 , 38 During ExECG, these responses may be monitored, providing insights into the cardiovascular response and being of relevance (as detailed below) in various clinical settings. 15 - 17 , 26 , 39 - 41 For example, for HR monitoring, its response can be of use when considering chronotropic incompetence as a cause of effort intolerance. 15 As for BP, an inability of systolic BP to increase (or a decrease during exercise) may be a harbinger of increased risk in entities ranging from aortic valve disease to hypertrophic cardiomyopathy.…”

“… 100 Interestingly, when considering interventions such as the implantation of a subcutaneous implantable cardioverter-defibrillator (namely in patients with Brugada syndrome), ExECG may also be useful in the screening process of potential candidates. 41 , 101 , 102 By analyzing ST-T segment changes during exercise, this framework may allow refinements in the approach to these patients as to avoid the occurrence of possible inappropriate therapies. 102 , 103 …”

Ventricular arrhythmias related to COVID‐19 infection and vaccination in patients with Brugada syndrome: The importance of a correct patient stratification

“…For these reasons, an accurate and multiparametric stratification of patients remains crucial and essential, and to date, implantable cardioverter defibrillator (ICD) implantation is the only established effective therapy to protect against sudden cardiac death in high-risk patients. 2,3 Moreover, in light of the most recent guidelines, the implantation of an implantable loop recorder (ILR) in patients with BrS does not find a transversal agreement. 4 It finds the diagnostic field only in low-risk patients with dubious symptoms, recognizing that the evidence to support this recommendation is modest and no long-term follow-up data are available, and the decisions regarding reimplantation of a second or third ILR in these patients are not addressed.…”

Appropriate and inappropriate therapies in patients with Brugada syndrome. What to expect? Authors’ reply

“… 3 Among those, patients with inherited arrhythmia syndromes (IASs), including Brugada syndrome (BrS), constitute a group of subjects, in whom such decision must often be made in early age, potentially exposing the patient not only to all benefits of ICD but also to lifetime risk of adverse events, such as lead-related complications, infections, or inappropriate therapies. 4 …”