Event rates and risk factors in patients with Brugada syndrome and no prior cardiac arrest: A cumulative analysis of the largest available studies distinguishing ICD-recorded fast ventricular arrhythmias and sudden death

Abstract Aims Risk stratification in Brugada syndrome (BrS) still represents an unsettled issue. In this multicentre study, we aimed to evaluate the clinical characteristics and the long-term clinical course of patients with BrS. Methods and results A total of 111 consecutive patients (86 males; aged 45.3 ± 13.3 years) diagnosed with BrS were included and followed-up in a prospective fashion. Thirty-seven patients (33.3%) were symptomatic at enrolment (arrhythmic syncope). An electrophysiological study (EPS) was performed in 59 patients (53.2%), and ventricular arrhythmias were induced in 32 (54.2%). A cardioverter defibrillator was implanted in 34 cases (30.6%). During a mean follow-up period of 4.6 ± 3.5 years, appropriate device therapies occurred in seven patients. Event-free survival analysis (log-rank test) showed that spontaneous type-1 electrocardiogram pattern (P = 0.008), symptoms at presentation (syncope) (P = 0.012), family history of sudden cardiac death (P < 0.001), positive EPS (P = 0.024), fragmented QRS (P = 0.004), and QRS duration in lead V2 > 113 ms (P < 0.001) are predictors of future arrhythmic events. Event rates were 0%, 4%, and 60% among patients with 0–1 risk factor, 2–3 risk factors, and 4–5 risk factors, respectively (P < 0.001). Current multiparametric score models exhibit an excellent negative predictive value and perform well in risk stratification of BrS patients. Conclusions Multiparametric models including common risk factors appear to provide better risk stratification of BrS patients than single factors alone.

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Early Repolarisation – What Should the Clinician Do?

Arrhythmia & Electrophysiology Review ◽

10.15420/aer.2015.04.02.96 ◽

2015 ◽

Vol 04 (2) ◽

pp. 96 ◽

Cited By ~ 3

Author(s):

Manoj N Obeyesekere ◽

Andrew D Krahn ◽

◽

Keyword(s):

Risk Factors ◽

Cardiac Arrest ◽

High Risk ◽

Ventricular Fibrillation ◽

Ventricular Arrhythmias ◽

Asymptomatic Patient ◽

Cardiac Risk ◽

Minimal Risk ◽

Cardiac Pathology ◽

History Of

The early repolarisation (ER) pattern is a common ECG finding. Most individuals with the ER pattern are at minimal risk for arrhythmic events. In others, ER increases the arrhythmic risk of underlying cardiac pathology. Rarely ER syndrome will manifest as a primary arrhythmogenic disorder causing ventricular fibrillation (VF). ER syndrome is defined as syncope attributed to ventricular arrhythmias or cardiac arrest attributed to ER following systematic exclusion of other etiologies. Some ECG features associated with ER portend a higher risk. However, clinically useful risk-stratifying tools to identify the asymptomatic patient at high risk are lacking. Patients with asymptomatic ER and no family history of malignant ER should be reassured. All patients with ER should continue to have modifiable cardiac risk factors addressed. Symptomatic patients should be systematically investigated, directed by symptoms.

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Risk factors for sudden death and cardiac arrest at the onset of fulminant type 1 diabetes mellitus

Diabetology International ◽

10.1007/s13340-015-0247-6 ◽

2015 ◽

Vol 7 (3) ◽

pp. 281-288 ◽

Cited By ~ 4

Author(s):

Megu Yamaguchi Baden ◽

Akihisa Imagawa ◽

Hiromi Iwahashi ◽

Iichiro Shimomura ◽

Takuya Awata ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 1 Diabetes ◽

Cardiac Arrest ◽

Sudden Death ◽

Type 1 Diabetes Mellitus ◽

Fulminant Type 1 Diabetes ◽

Fulminant Type

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The risk of sudden cardiac death or ventricular arrhythmias on Immune checkpoint Inhibitors

European Heart Journal ◽

10.1093/ehjci/ehaa946.3488 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Mirabel ◽

P Karapetiantz ◽

E Marijon ◽

C Le Beller ◽

Z Reda Al-Sayed ◽

...

Keyword(s):

Cardiac Arrest ◽

Sudden Cardiac Death ◽

Sudden Death ◽

Cell Carcinoma ◽

Immune Checkpoint ◽

Cardiac Death ◽

Ventricular Arrhythmias ◽

Immune Checkpoint Inhibitors ◽

Checkpoint Inhibitors ◽

World Health

Abstract Background Immune checkpoint inhibitors (ICI) have significantly improved the prognosis of many advanced cancers, and may be given in non-metastatic cancer in the near future. ICI have recently been reported to induce fulminant cardiotoxic effects such as myocarditis, responsible for ∼50% mortality rates. Objective To estimate the risk of sudden death (SD) and ventricular arrhythmias in patients receiving ICI using the World Health Organization individual case safety report (ICSR) database, Vigibase (WHO international pharmacovigilance database). Methods The system organ class MEDRA was used to identify cases as ICSR with the terms sudden death, sudden cardiac death, cardiac arrest, ventricular fibrillation, ventricular tachycardia, ventricular arrhythmia and torsades de pointes (named as SD events) from Nov 1967 to Nov 2019. We used the ATC code L01 which regroups 219 antineoplastic agents including ICI avelumab (anti-PDL1), ipilimumab (anti CTLA4), nivolumab (anti-PD1) and pembrolizumab (anti-PD1). A disproportionality analysis was performed to estimate of relative Odds Ratio (ROR). Signals were considered significant when the lower boundary of the 99.97% confidence interval (ROR0.25) was ≥1. Results We found that avelumab was significantly associated with SD events (ROR0.25=1.7). This overreporting was not observed for other ICIs. Avelumab was associated with 12 cases of cardiac arrest (n=11) or sudden death (n=1), which were reported since 2017 as the drug became available. There were however no signals regarding other terms including ventricular arrhythmias. Conclusions In spite of the potential severity of ICI-myocarditis, ICI do not appear as associated with the occurrence of sudden death or life-threatening arrhythmias, with the exception of avelumab (anti-PDL1), one of the latest developed ICI, indicated in metastatic Merkel cell carcinoma and advanced renal cell carcinoma. Further attention is warranted to confirm this signal that may vary among ICI therapies. Funding Acknowledgement Type of funding source: None

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Rhabdomyoma of the interventricular septum presenting as a Brugada phenocopy

Cardiology in the Young ◽

10.1017/s1047951111000424 ◽

2011 ◽

Vol 21 (5) ◽

pp. 591-594 ◽

Cited By ~ 7

Author(s):

Timothy Nguyen ◽

John Smythe ◽

Adrian Baranchuk

Keyword(s):

Sudden Death ◽

Brugada Syndrome ◽

Ventricular Arrhythmias ◽

Interventricular Septum ◽

St Segment Elevation ◽

St Segment ◽

The Right

AbstractBrugada syndrome is a channelopathy characterised electrocardiographically by distinctive coved ST-segment elevation in the right precordial leads and is associated with a predisposition for sudden death secondary to ventricular arrhythmias in otherwise healthy patients. Previously known as Brugada-like patterns, Brugada phenocopies include agents and conditions that mimic true Brugada syndrome, presenting with an acquired Brugada Type-1 ECG pattern. We describe the first reported case of a 17-month-old female with an asymptomatic rhabdomyoma of the interventricular septum that presented as a Brugada phenocopy.

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Abstract 17352: Predictors of Ventricular Arrhythmias and Sudden Death in a Quebec Cohort With Brugada Syndrome

Circulation ◽

10.1161/circ.132.suppl_3.17352 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Lena Rivard ◽

Antoine Roux ◽

Isabelle Nault ◽

Jean Champagne ◽

Jean-Francois Roux ◽

...

Keyword(s):

Sudden Death ◽

Brugada Syndrome ◽

Ventricular Arrhythmias ◽

Cox Regression ◽

Type I ◽

Left Truncation ◽

University Hospitals ◽

History Of ◽

Qrs Duration

Introduction: Patients with Brugada syndrome (BrS) are at risk for ventricular arrhythmias (VAs) and sudden death. Identification of high-risk individuals beyond those with syncope or resuscitated SCD remains a major challenge. We sought to assess the value of clinical, electrophysiological, and ECG features of depolarization and repolarization in predicting arrhythmic events and SCD in a Quebec population. Methods: Consecutive patients with BrS diagnosed between 2002 and 2013 were recruited from three major university hospitals in the province of Quebec, Canada. Relevant clinical features were recorded at baseline. Qualifying ECGs with the highest type 1 ST-segment elevations were reviewed and analyzed by two electrophysiologists blinded to clinical history, with the following parameters assessed: S duration in V1, aVR sign, QRS duration in V6, R-J interval in V2, maximal Tp-e, duration, Tp-e dispersion, QRS-f, ST elevation and QTc in V2, and presence of an inferolateral ER pattern. Survival analyses considered a left truncation model to account for potential sampling bias, considering that those who died suddenly before recognition of BrS were necessarily excluded. Results: A total of 105 consecutive patients, 79.8% male, were diagnosed with BrS at a median age of 48 years and were followed for 5.0±1.2 years. Ten (9.5%) had a history of SCD, 37 (35.2%) had syncope, and 7 (6.7%) experienced 20 arrhythmic events during follow-up (7 anti-tachycardia pacing; 13 shocks). In multivariate Cox regression analyses adjusted for left truncation and Firth bias correction, a spontaneous type I ECG pattern (HR 10.80; 95% CI 1.03 to 113.87; p=0.0476)], maximal Tp-e duration ≥100ms (HR 29.73; 95% CI 1.33 to 666.37; p= 0.0325) and QRS duration in V6>110 ms (HR 15.27; 95% CI 1.07 to 217.42; p=0.0443) were independently associated with VAs or aborted SCD. Family history of SCD, AF, and inducible VAs during programmed ventricular stimulation were not associated with the primary endpoint. Conclusion: In a cohort of patients with BrS from the province of Quebec, VAs and SCD were independently associated with standard 12-lead ECG features including a spontaneous type 1 pattern, depolarization (QRS in V6 >110 ms), and repolarization (maximal Tp-e duration) criteria.

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