Unsuccessful Internal Defibrillation in Brugada Syndrome: Focus on Refractoriness and Ventricular Fibrillation Cycle Length

Watanabe, Hiroshi; Chinushi, Masaomi; Sugiura, Hirotaka; Washizuka, Takashi; Komura, Satoru; Hosaka, Yukio; Furushima, Hiroshi; Hayashi, Jun‐Ichi; Aizawa, Yoshifusa

doi:10.1046/j.1540-8167.2005.40579.x

Cited by 32 publications

(22 citation statements)

References 24 publications

(36 reference statements)

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“…We found that 12% of the patients had a DFT Ͼ21 joules, whereas 4.6% 20 to 6.2% of patients with structural heart disease 21 are reported to have a high DFT. A previous study by Watanabe et al 19 found 18% of 22 Brugada patients with a DFT Ͼ25 joules versus 0% in the group implanted with ICDs for structural heart disease. Two hypotheses have been proposed to explain these findings.…”

Section: Icd Implantation Parametersmentioning

confidence: 93%

“…With regard to implantation data, it has been suggested that Brugada patients have high DFTs 19 and high pacing thresholds. We found that 12% of the patients had a DFT Ͼ21 joules, whereas 4.6% 20 to 6.2% of patients with structural heart disease 21 are reported to have a high DFT.…”

Section: Icd Implantation Parametersmentioning

confidence: 99%

“…First, the right ventricular outflow tract seems to be a critical area in Brugada patients, 22 and the energy required to achieve an adequate current density to prolong refractoriness in the majority of the myocardium and especially in the epicardium of the right ventricular outflow tract may be more important. Secondly, the refractoriness of the myocardium induced by the defibrillation shock may fail to prevent VF reinitiation because of a short VF cycle length and short ventricular refractory period 19 in this population.…”

Section: Icd Implantation Parametersmentioning

confidence: 99%

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Outcome After Implantation of a Cardioverter-Defibrillator in Patients With Brugada Syndrome

Sacher¹,

Probst²,

Maury³

et al. 2006

Circulation

276

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Background-Brugada syndrome is an arrhythmogenic disease characterized by an increased risk of sudden cardiac death (SCD) by ventricular fibrillation. At present, an implantable cardioverter-defibrillator (ICD) is the recommended therapy in high-risk patients. This multicenter study reports the outcome of a large series of patients implanted with an ICD for Brugada syndrome. Methods and Results-All patients (nϭ220, 46Ϯ12 years, 183 male) with a type 1 Brugada ECG pattern implanted with an ICD in 14 centers between 1993 and 2005 were investigated. ICD indication was based on resuscitated SCD (18 patients, 8%), syncope (88 patients, 40%), or positive electrophysiological study in asymptomatic patients (99 patients, 45%). The remaining 15 patients received an ICD because of a family history of SCD or nonsustained ventricular arrhythmia. During a mean follow-up of 38Ϯ27 months, no patient died and 18 patients (8%) had appropriate device therapy (10Ϯ15 shocks/patient, 26Ϯ33 months after implantation). The complication rate was 28%, including inappropriate shocks, which occurred in 45 patients (20%, 4Ϯ3 shocks/patient, 21Ϯ20 months after implantation). The reasons for inappropriate therapy were lead failure (19 patients), T-wave oversensing (10 patients), sinus tachycardia (10 patients), and supraventricular tachycardia (9 patients). Among implantation parameters, high defibrillation threshold, high pacing threshold, and low R-wave amplitude occurred, respectively, in 12%, 27%, and 15% of cases. Conclusion-In this large Brugada syndrome population, a low incidence of arrhythmic events was found, with an annual event rate of 2.6% during a follow-up of Ͼ3 years, in addition to a significant risk of device-related complications (8.9%/year). Inappropriate shocks were 2.5 times more frequent than appropriate ones. (Circulation.

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Section: Icd Implantation Parametersmentioning

confidence: 93%

Section: Icd Implantation Parametersmentioning

confidence: 99%

Section: Icd Implantation Parametersmentioning

confidence: 99%

See 1 more Smart Citation

Outcome After Implantation of a Cardioverter-Defibrillator in Patients With Brugada Syndrome

Sacher¹,

Probst²,

Maury³

et al. 2006

Circulation

276

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“…10 It is mainly observed in patients with ICD dysfunction, 11 lead dislocation, 12 structural heart disease such as hypertrophic cardiomyopathy, 13,14 reduced ejection fraction, electrical storm, 15 metabolic decompensation, 16 and Brugada syndrome. 17 An initial report by Bardy et al 6 showed that the S-ICD successfully detected and treated all 12 episodes of spontaneous sustained ventricular tachycardia. However, these episodes occurred in only 3 patients, with 1 patient experiencing an electrical storm.…”

Section: Ineffective Shock Delivery In S-icd and Transvenous Icdsmentioning

confidence: 99%

Shock Efficacy of Subcutaneous Implantable Cardioverter-Defibrillator for Prevention of Sudden Cardiac Death

Aydin¹,

Hartel²,

Schlüter³

et al. 2012

Circ: Arrhythmia and Electrophysiology

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However, with the increasing application of transvenous ICDs and higher patients' life expectancy, long-term technical difficulties, such as lead failure or device infection, have become important issues in clinical practice. [2][3][4] In addition, complications during lead placement, such as lead dislocation, perforation, or pneumothorax, bear a substantial perioperative risk. 5 The subcutaneous ICD (S-ICD) offers an alternative, novel approach to avoid lead-associated complications. 6 A first report from a single center has shown a promising device performance, with a sensitivity of 100% to detect ventricular tachyarrhythmia and 100% cardioversion efficacy. 7 Here, we report an initial multicenter experience with patients offered the S-ICD for both primary and secondary preventions of sudden cardiac death. Clinical Perspective on p 919 Methods PatientsThe study included all 40 consecutive patients (42±15 years [range, 19-73 Correspondence to Ali Aydin, MD, Department of Cardiology/Electrophysiology, University Heart Center, University Medical Center HamburgEppendorf, Martinistr, 5220246 Hamburg, Germany. E-mail aydin@uke.de Background-Recently, subcutaneous implantable cardioverter-defibrillator (S-ICD) has become available. The aim of our study was to assess the efficacy of S-ICD in a clinical setting. Table 1. Of note, the majority of our patients had an indication for secondary prevention (n=23; 58%). Methods and Results-Between Patient SelectionFiles of all patients receiving an S-ICD between June 2010 and July 2011 at the participating institutions were reviewed for this report. Patients were selected for an S-ICD if they fulfilled the indication criteria specified by the American College of Cardiology/ American Heart Association/European Society of Cardiology guidelines for primary or secondary prevention of sudden cardiac death. 1According to the recommendations given by the manufacturer, the S-ICD was not implanted in patients with symptomatic bradycardia, incessant ventricular tachycardia, or documented spontaneous, frequently recurring ventricular tachycardia that was reliably terminated with antitachycardia pacing. Patients with pacemakers were also classified as not suitable for an S-ICD. ECG morphology was preoperatively screened in accordance with the recommendations of the manufacturer to exclude patients with atrioventricular block, bundle branch block, and long-QT interval. S-ICD therapy was offered to all patients who fulfilled the criteria mentioned above; therefore, the patients' preference was 1 decision factor on transvenous ICD versus S-ICD. Also, patients with previous transvenous ICDs and an indication for removal were given the choice for another transvenous ICD or the S-ICD. Magnetic resonance tomography or transthoracic echocardiography was performed to assess left ventricular ejection fraction. Subcutaneous ICD SystemA commercially available S-ICD system (pulse generator model SQ-RX 1010 and subcutaneous lead model Q-Trak 3010, both from Cameron Health Inc, San Clemente, CA) wa...

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“…The study of Watanabe et al [12] examined the incidence of VF not responding to internal defibrillation and found an incidence of 18%. One explanation could be the origin of the electrical abnormality at the level of RVOT [13] with defibrillation shock delivered between the right ventricular apex and left subclavicular can.…”

Section: Unsuccessful Internal Defibrillation In Brugada Syndromementioning

confidence: 99%

ICD Electrograms in Patients with Brugada Syndrome

Cismaru¹,

S²,

Gușetu³

et al. 2017

Interpreting Cardiac Electrograms - From Skin to Endocardium

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In patients with Brugada syndrome, implantable cardioverter-defibrillator (ICD) is the only demonstrated treatment that prevents sudden cardiac death. The progress in ICD technology improved the diagnosis and efficacy of implantable devices in the management and treatment of ventricular tachycardia (VT) and ventricular fibrillation (VF). Recording of electrical events just before and after a delivered or aborted ICD therapy permits a more accurate characterization of the rhythm but also provides information on the electrical events preceding the arrhythmia. This chapter aims to gain insight into the mechanism of initiation and termination of spontaneous VF by analyzing intracardiac electrograms (IEGM) in Brugada patients implanted with ICDs. It has two parts:(1) update on ICD electrograms in Brugada syndrome patients, where we review the medical literature on ICD electrograms and their use for detecting electrical manifestations of Brugada syndrome, and (2) examples of ICD electrograms, from our own database of patients affected by Brugada syndrome.

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Unsuccessful Internal Defibrillation in Brugada Syndrome: Focus on Refractoriness and Ventricular Fibrillation Cycle Length

Abstract: Patients with Brugada syndrome have a high prevalence of high defibrillation energy requirement, and short ventricular ERP and VFCL.

Cited by 32 publications

References 24 publications

Outcome After Implantation of a Cardioverter-Defibrillator in Patients With Brugada Syndrome

Outcome After Implantation of a Cardioverter-Defibrillator in Patients With Brugada Syndrome

Shock Efficacy of Subcutaneous Implantable Cardioverter-Defibrillator for Prevention of Sudden Cardiac Death

ICD Electrograms in Patients with Brugada Syndrome

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