Evaluation of Syncope in Brugada Syndrome
The Effect on Outcome Risk stratification in pts with Brugada syndrome (BS) is difficult. The report from the 2
nd Consensus Committee on BS suggests that all pts with syncope without a ¡°clear extracardiac cause?should have an implantable cardioverter-defibrillator (ICD). However a clear cause for syncope may be difficult to prove.
Methods
All pts diagnosed with BS at Bordeaux CHU between 1999 and 2009 have been enrolled in a prospective registry. All patients with syncope were enrolled in the present study (Group 1 without and Group 2 with a ¡°clear extracardiac cause?of syncope). Patients were followed in the clinic or by phone annually unless there was an event.
Results
Of 185 pts with BS, 49 (39 male, 47 ¡À12yo) had at least one syncope. All 27 pts in group 1 received an ICD. Of the 22 pts in group 2, 4 received an implantable loop recorder [MJW1] (ILR) and 1 patient received an ICD after positive EP study.
With a mean follow-up of 53 ¡À38 months, 19 pts were asymptomatic, 5 had appropriate ICD therapy, 2 patients had further syncopal events not associated with cardiac arrhythmia and 1 pt died of a non cardiac cause in group 1. In group 2, 14pts were asymptomatic, 5 had recurrent atypical syncopal events (without arrhythmia shown by ILR in 3 pts), 2 experienced atypical chest pain and 1 died of drug abuse.
Conclusions
| group 1 27 patients syncope without a clear extracardiac cause | group 2 22 patients syncope with a clear extracardiac cause | p |
|---|
| gender (male) | 21 (80.8 % ) | 18 (78.3 % ) | 0.83 |
| age (years old) | 48 (+/- 12.2) | 45 (+/- 11) | 0.39 |
| follow-up (months) | 53 (+/- 36.1) | 52 (+/- 42.3) | 0.90 |
| spontaneous type 1 ECG | 21 (80.8 % ) | 13 (56.5 % ) | 0.07 |
| EP Study: |
| ?positive | 8 (29.7 % ) | 1 (4.5 % ) | 0.06 |
| ?negative | 13 (48 % ) | 17 (77.3 % ) | |
| ?not done | 6 (22.3 % ) | 4 (18.2 % ) | |
| circunstances of diagnosis: |
| ?unexpected finding | 4 (14.8 % ) | 7 (31.8 % ) | 0.43 |
| ?familial assessment | 2 (7.4 % ) | 2 (9.1 % ) | |
| ?syncope | 21 (77.8 % ) | 13 (59.1 % ) | |
