loading page

Inappropriate shock in Brugada syndrome: incidence and predictors in patients with a subcutaneous implantable cardiac defibrillator
  • +6
  • Gavino Casu,
  • Etelvino Silva,
  • Felipe Bisbal,
  • Graziana Viola,
  • Pierluigi Merella,
  • Giovanni Lorenzoni,
  • Giovanni Motta,
  • Stefano Bandino,
  • Paola Berne
Gavino Casu
Ospedale San Francesco
Author Profile
Etelvino Silva
Hospital CLinic i Provincial de Barcelona
Author Profile
Felipe Bisbal
Hospital Clinic
Author Profile
Graziana Viola
Ospedale San Francesco
Author Profile
Pierluigi Merella
Ospedale San Francesco
Author Profile
Giovanni Lorenzoni
Ospedale San Francesco
Author Profile
Giovanni Motta
Ospedale San Francesco
Author Profile
Stefano Bandino
Ospedale San Francesco
Author Profile
Paola Berne
Ospedale San Francesco
Author Profile

Abstract

Abstract Background: Subcutaneous implantable cardioverter defibrillators (S-ICDs) avoid complications secondary to transvenous leads, but inappropriate shocks (ISs) are frequent. Furthermore, IS data from patients with Brugada syndrome (BrS) with an S-ICD are scarce. Objective: We aimed to establish the incidence, mechanisms, and predictors of S-ICD in this population. Methods: We analyzed the clinical and electrocardiographic characteristics, automated screening test data, device programming, and IS occurrence in adult patients with BrS with an S-ICD. Results: Thirty-nine patients were enrolled (69% male, mean age at diagnosis 46±13 years, mean age at implantation 48±13 years). During a mean follow-up of 26±21 months, 18% patients experienced IS. Patients with IS were younger at the time of diagnosis (36±8 versus 48±13 years, p=0.018) and S-ICD implantation (38±9 versus 50±23 years, p=0.019) and presented with spontaneous type 1 Brugada ECG pattern more frequently at diagnosis or during follow-up (71% versus 25%, p=0.018). During automated screening tests, patients with IS showed lower QRS voltage in the primary vector in the supine position (0.58±0.26 versus 1.10±0.35 mV, p=0.011) and lower defibrillator automated screening score (DASS) in the primary vector in the supine (123±165 versus 554±390 mV, p=0.005) and standing (162±179 versus 486±388 mV, p=0.038) positions. Age at diagnosis was the only independent predictor of IS (hazard ratio=0.873, 95% confidence interval: 0.767-0.992, p=0.037). Conclusion: IS was a frequent complication in patients with BrS with an S-ICD. Younger age was independently associated with IS. A more thorough screening process might help prevent IS in this population.

Peer review status:ACCEPTED

11 Jan 2021Submitted to Journal of Cardiovascular Electrophysiology
16 Jan 2021Submission Checks Completed
16 Jan 2021Assigned to Editor
18 Jan 2021Reviewer(s) Assigned
21 Feb 2021Review(s) Completed, Editorial Evaluation Pending
23 Feb 2021Editorial Decision: Revise Minor
18 Mar 20211st Revision Received
24 Mar 2021Submission Checks Completed
24 Mar 2021Assigned to Editor
24 Mar 2021Reviewer(s) Assigned
16 Apr 2021Review(s) Completed, Editorial Evaluation Pending
19 Apr 2021Editorial Decision: Accept