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The Utility of Drug Challenge Testing in Brugada Syndrome: a Systematic Review and Meta-analysis
  • +6
  • Pattara Rattanawong,
  • Jakrin Kewcharoen,
  • Chanavuth Kanitsoraphan,
  • Wasawat Vutthikraivit,
  • Prapaipan Putthapiban,
  • Narut Prasitlumku,
  • Poemlarp Mekraksakit,
  • Raktham Mekritthikrai,
  • Eugene Chung
Pattara Rattanawong
Mayo Clinic Arizona
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Jakrin Kewcharoen
University of Hawaii Internal Medicine Residency Program
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Chanavuth Kanitsoraphan
University of Hawaii Internal Medicine Residency Program
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Wasawat Vutthikraivit
Texas Tech University Health Sciences Center
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Prapaipan Putthapiban
Albert Einstein Medical Center
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Narut Prasitlumku
University of Hawaii Internal Medicine Residency Pr
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Poemlarp Mekraksakit
Phramongkutklao College of Medicine
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Raktham Mekritthikrai
University of Hawaii Internal Medicine Residency Program
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Eugene Chung
University of Michigan Health System
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Peer review status:ACCEPTED

25 Apr 2020Submitted to Journal of Cardiovascular Electrophysiology
27 Apr 2020Submission Checks Completed
27 Apr 2020Assigned to Editor
28 Apr 2020Reviewer(s) Assigned
11 May 2020Review(s) Completed, Editorial Evaluation Pending
12 May 2020Editorial Decision: Revise Minor
01 Jun 20201st Revision Received
02 Jun 2020Assigned to Editor
02 Jun 2020Submission Checks Completed
02 Jun 2020Reviewer(s) Assigned
14 Jun 2020Review(s) Completed, Editorial Evaluation Pending
15 Jun 2020Editorial Decision: Revise Minor
16 Jun 20202nd Revision Received
17 Jun 2020Submission Checks Completed
17 Jun 2020Assigned to Editor
17 Jun 2020Reviewer(s) Assigned
20 Jun 2020Review(s) Completed, Editorial Evaluation Pending
21 Jun 2020Editorial Decision: Accept

Abstract

Introduction: Brugada syndrome is associated with ventricular arrhythmia leading to sudden cardiac death. Risk stratification is challenging, as major arrhythmic events (MAE) are rare. We assessed the utility of drug challenge testing in Brugada syndrome by a systematic review and meta-analysis. Methods and results: We comprehensively searched the databases of MEDLINE and EMBASE from inception to May 2019. Included studies compared the incidence of MAE between spontaneous and drug challenge induced Type-1. Data were combined using the random-effects, generic inverse variance method, to calculate pooled incidence and odds ratio (OR). Mixed-effects Poisson regression was used to calculated incidence rate ratio (IRR). Eighteen studies from 2006 to 2018 were included (4,099 patients, mean follow-up 4.5 years). Pooled annual incidences of MAE in spontaneous, drug challenge induced (regardless of symptoms), asymptomatic drug challenge induced, and symptomatic drug challenge induced Type-1 were 23.8 (95% confidence interval [CI]: 19.8-27.8), 6.5 (95% CI: 3.9-9.1), 2.1 (95% CI: -0.3-4.4), and 19.6 (95% CI: 9.9-29.3) per 1,000 person-years respectively. The incidence of MAE between symptomatic drug challenge induced and asymptomatic spontaneous Type-1 was not statistically different (IRR=1.0, 95%CI: 0.6-1.7). The presence of ventricular tachyarrhythmia during drug challenge testing was a predictor of MAE (OR=3.73, 95% CI: 1.77-7.86, p=0.001). Conclusions: The incidence of MAE in drug challenge induced Type-1 in asymptomatic patients is low. The incidence of MAE between symptomatic drug challenge induced and asymptomatic spontaneous Type-1 was similar. Ventricular tachyarrhythmia during drug challenge testing could be a useful risk marker for MAE in Brugada syndrome.