Evolución clínica de pacientes con síndrome de Brugada y desfibriladores automáticos implantados. Experiencia en dos centros de atención terciaria.
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Introducción: El desfibrilador automático implantable es opción terapéutica en pacientes de alto riesgo con síndrome de Brugada (SB). El objetivo fue describir la evolución clínica de una serie de pacientes con SB y desfibriladores implantados en dos centros de atención terciaria.
Métodos: Entre abril/1998 y noviembre/2019 se implantaron desfibriladores a 64 pacientes con SB. Se realizó seguimiento al mes, a los 3 meses y semestralmente.
Resultados: Diecinueve debutaron con muerte súbita cardiaca (MSC) abortada, 36 con síncopes y 9 estaban asintomáticos, edad media 43.8 años, 49 del sexo masculino. El 96.2% tenía electrocardiograma convexo espontáneo en al menos una derivación precordial derecha y 12 antecedentes familiares de MSC. Se realizó estimulación eléctrica programada a 52, 12 fueron inducibles. Catorce presentaron complicaciones relacionadas con el sistema electrodo/generador y 19 tuvieron choques inadecuados. Dos pacientes tomaron sulfato de quinidina desde el implante por arritmias auriculares y dos fallecieron en circunstancias no aclaradas, del resto, en un seguimiento medio de 120.5±74.8 meses, 17 (28.3%) tuvieron choques adecuados, 12 habían debutado con MSC y 5 con síncopes, los factores de riesgo para presentar arritmias ventriculares malignas fueron: sexo masculino, MSC abortada al debut, mayor seguimiento y choques inadecuados. La supervivencia (Kaplan Meier) fue inferior en sintomáticos versus asintomáticos (p=0,042), y en debutantes con MSC versus con síncope (p=0,0034).
Conclusiones: Los pacientes sintomáticos con SB son de alto riesgo. Las complicaciones a largo plazo relacionadas con los desfibriladores automáticos implantados son trascendentes. La decisión de implantar desfibriladores a pacientes asintomáticos continúa siendo un desafío clínico.
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Referencias
-Wilde AM, Antzelevitch C, Borggrefe M, Brugada J, Brugada R, Brugada R, et al. Proposed diagnostic criteria for the Brugada syndrome. Consensus report. Circulation. 2002;106:2514-9.
-Sieira J, Brugada P. The definition of the Brugada syndrome. Eur Heart J. 2017;38:3029-3.
-Lee S, Li KHC, Zhou J, Leung KSK, Lai RWC, Li G, et al. Outcomes in Brugada syndrome patients with implantable cardioverter-defibrillators: Insights from the SGLT2 registry. Front. Physiol. 2020. DOI: 10.3389/fphys.2020.00204.
-Hernandez-Ojeda J, Arbelo E, Borras R, Berne P, Tolosana JM, Gomez-Juanatey A, et al. Patients with Brugada syndrome and implanted cardioverter-defibrillators. Long-term follow-up. Am Coll Cardiol. 2017;70:1991-2002.
-Pappone C, Brugada J, Vicedomini G, Ciconte G, Manguso F, Saviano M, et al. Electrical substrate elimination in 135 consecutive patients with Brugada syndrome. Circ Arrhythm Electrophysiol. 2017. DOI: 10.1161/CIRCEP.117.005053.
-Belhassen B. Management of Brugada syndrome 2016: should all high risk patients receive an ICD?. Alternatives to implantable cardiac defibrillator therapy for Brugada syndrome. Circ Arrhythm Electrophysiol. 2016. DOI: 10.1161/CIRCEP.116. 004185.
-Sieira J, Brugada P. Management of Brugada syndrome 2016: should all high risk patients receive an ICD?. All high-risk patients should receive an implantable cardiac defibrillator. Circ Arrhythm Electrophysiol. 2016. DOI: 10.1161/CIRCEP.116. 004195.
-Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, et al. 2017 AHA/ACC/HRS Guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. JACC. 2018;72:e91-e220.
-Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, et al. J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge. Endorsed by the Asia Pacific Heart Rhythm Society (APHRS), the European Heart Rhythm Association (EHRA), the Heart Rhythm Society (HRS), and the Latin American Society of Cardiac Pacing and Electrophysiology (Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiología [SOLAECE]). Europace. 2017;19:665-9.
-Antzelevitch C, Brugada P, Borggrefe M, Brugada J, Brugada R, Corrado D, et al. Brugada syndrome. Report of the second consensus conference. Circulation. 2005;111:659-70.
-Priori SG, Napolitano C, Gasparini M, Pappone C, Della Bella P, Giordano H, et al. Natural history of Brugada syndrome: insights for risk stratification and management. Circulation. 2002;105:1342-7.
-Brugada J, Brugada R, Antzelevitch C, Towbin J, Nademanee K, Brugada P. Long-term follow-up of individuals with the electrocardiographic pattern of right bundle branch block and ST-segment elevation in precordial leads V1 to V3. Circulation. 2002;105:73-8.
-Eckardt L, Probst V, Smits JPP, Schulze E, Wolpert C, Schimpf R, et al. Long-term prognosis of individuals with right precordial ST-segment elevation Brugada syndrome. Circulation. 2005;111:257-63.
-Probst V, Veltmann C, Eckardt L, Meregalli PG, Gaita F, Tan HL, et al. Long-term prognosis of patients diagnosed with Brugada syndrome: Results from the FINGER Brugada syndrome registry. Circulation. 2010;121:635-43.
-Brugada P, Brugada R, Brugada J, Geelen P. Use of the prophylactic implantable cardioverter defibrillator for patients with normal hearts. Am J Cardiol. 1999;83:98D-100D.
-Brugada P, Brugada R, Brugada J. Should patients with an asymptomatic Brugada electrocardiogram undergo pharmacological and electrophysiological testing? Circulation. 2005;112:279-92.
-Priori SG, Napolitano C. Should patients with an asymptomatic Brugada electrocardiogram undergo pharmacological and electrophysiological testing? Circulation. 2005;112:279-92.
-Sacher F, Probst V, Iesaka Y, Jacon P, Laborderie J, Mizon-Gérard F, et al. Outcome after implantation of a cardioverter-defibrillator in patients with Brugada syndrome: A multicenter study. Circulation. 2006;114:2317-24.
-Sarkozy A, Boussy T, Kourgiannides G, Chierchia GB, Richter S, De Potter T, et al. Long-term follow-up of primary prophylactic implantable cardioverter-defibrillator therapy in Brugada syndrome. Eur Heart J. 2007;28:334-44.
-Kharazi A, Emkanjoo Z, Alizadeh A, Nikoo M H, Jorat M V, SadrAmeli MA. Mid-term follow-up of patients with Brugada syndrome following a cardioverter defibrillator implantation: a single center experience. Indian Pacing Electrophysiol J. 2007;7:33-9.
-Rosso R, Glick A, Glikson M, Wagshal A, Swissa M, Rosenhek S, et al. Outcome after implantation of cardioverter defribrillator in patients with Brugada syndrome: a multicenter Israeli study (ISRABRU). Isr Med Assoc J. 2008;10:435-9.
-Sacher F, Probst V, Maury P, Mansourati J, Komatsu Y, Marquie C et al. Outcome after implantation of a cardioverter-defibrillator in patients with Brugada syndrome: a multicenter study–part 2. Circulation 2013;128:1739-47.
-Miyazaki S, Uchiyama T, Komatsu Y, Taniguchi H, Kusa S, Nakamura H, et al. Long-term complications of implantable defibrillator therapy in Brugada syndrome. Am J Cardiol. 2013;111:1448-51.
-Conte G, Sieira J, Ciconte G, de Asmundis C, Chierchia GB, Baltogiannis G et al. Implantable cardioverter-defibrillator therapy in Brugada syndrome: a 20-year single-center experience. J Am Coll Cardiol. 2015;65:879-88.
-Bordachar P, Reuter S, Garrigue S, Cai X, Hocini M, Jais P, et al. Incidence, clinical implications and prognosis of atrial arrhythmias in Brugada syndrome. Eur Heart J. 2004;25:879-84.
-Dereci A, Yap SC, Schinkel AFL. Meta-analysis of clinical outcome after implantable cardioverter-defibrillator implantation in patients with Brugada syndrome. J Am Coll Cardiol. 2019;5:141-8.
-El-Battrawy I, Roterberg G, Liebe V, Ansari U, Lang S, Zhou X, et al. Implantable cardioverter-defibrillator in Brugada syndrome: long-term follow-up. Clinical Cardiology. 2019;42:958-65.
-Olde Nordkamp LRA, Postema PG, Knops RE, Van Dijk N, Limpens J, Wilde AM, et al. Implantable cardioverter-defibrillator harm in young patients with inherited arrhythmia syndromes: a systematic review and meta-analysis of inappropriate shocks and complications. Heart Rhythm. 2016;13:443-54.
-Stix G, Della Bella P, Carbucicchio C, Schmidinger H. Spatial and temporal heterogeneity of depolarization and repolarization may complicate implantable cardioverter defibrillator therapy in Brugada syndrome. J Cardiovasc Electrophysiol. 2000;11:516-21.
-Rodriguez-Mañero M, De Asmundis C, Sacher F, Arbelo E, Probst V, Castro-Hevia J, et al. T-wave oversensing in patients with Brugada syndrome: true bipolar versus integrated bipolar implantable cardioverter defibrillator leads: multicenter retrospective study. Circ Arrhythm Electrophysiol. 2015;8:792-8.
-Veltmann C, Kuschyk J, Schimpf R, Streitner F, Schoene N, Borggrefe M, et al. Prevention of inappropriate ICD shocks in patients with Brugada syndrome. Clin Res Cardiol. 2010;99:37-44.
-Spragg DD, Berger RD. How to avoid inappropriate shocks. Heart Rhythm. 2008;5:762-5.
-Moss AJ, Schuger C, Beck CA, Brown MW, Cannom DS, Daubert JP, et al. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med. 2012;367:2275-83.
-Alter P, Waldhans S, Plachta E, Moosdorf R, Grim W. Complications of implantable cardioverter defibrillator therapy in 440 consecutive patients. PACE. 2005;28:926-32.
-Kirkfeldt RE, Johansen JB, Nohr EA, Jorgensen OD, Nielsen JC. Complications after cardiac implantable electronic device implantations: an analysis of a complete, nationwide cohort in Denmark. Eur Heart J. 2014;35:1186-94.
-Ranasinghe I, Parzynski CS, Freeman JV, Dreyer RP, Ross JS, Akar JG, et al. Long-term risk for device-related complications and reoperations after implantable cardioverter defibrillator implantation: an observational cohort study. Ann Int Med. 2016;165:20-9.
-Kleemann T, Becker T, Doenges K, Vater M, Senges J, Schneider S, et al. Annual rate of transvenous defibrillation lead defects in implantable cardioverter-defibrillators over a period of 10 years. Circulation 2007;115:2474-80.
-Bonny A, Talle MA, Vaugrenard T, Taieb J, Ngantcha M. Inappropriate implantable cardioverter-defibrillator shocks in Brugada syndrome: pattern in primary and secondary prevention. Indian Pacing Electrophysiol J. 2017;17:10-5.
-Steven D, Roberts-Thomson KC, Inada K, Seiler J, Koplan BA, Tedrow UB, et al. Long-term follow-up in patients with presumptive Brugada syndrome treated with implanted defibrillators. J Cardiovasc Electrophysiol. 2011;22:1115-9.
-Daoulah A, Alsheikh-Ali AA, Ocheltree AH, Al Fagih AR, Al-Samadi FM, Almusaad AM, et al. Outcome after implantable cardioverter defibrillator in patients with Brugada syndrome: the Gulf Brugada Syndrome registry. J Electrocardiol. 2012;45:327-32.
-Abud AM, Carlessi A, Goyeneche R, Strada B, Arceluz M, Fernandez A, et al. Retrospective analysis of patients with Brugada syndrome and implantable cardioverter defibrillator. Rev Argent Cardiol. 2014;82:21-5.
-Makarawate P, Chaosuwannakit N, Vannaprasaht S, Tassaneeyakul W, Sawanyawisuth K. Clinical characteristics and treatment outcomes of patients with Brugada syndrome in Northeastern Thailand. Singapore Med J. 2014;55:217-20.
-Conte G, Sieira J, Ciconte G, de Asmundis C, Chierchia GB, Baltogiannis G, et al. Implantable cardioverter-defibrillator therapy in Brugada syndrome: a 20-year single-center experience. J Am Coll Cardiol. 2015;65:879-88.
-Schukro C, Berger T, Stix G, Pezawas T, Kastner J, Hintringer F, et al. Regional prevalence and clinical benefit of implantable cardioverter defibrillators in Brugada syndrome. Int J Cardiol. 2010;144:191-4.
-Son MK, Byeon K, Park S-J, Kim JS, Nam JB, Choi KJ, et al. Prognosis after implantation of cardioverter-defibrillators in Korean patients with Brugada syndrome. Yonsei Med J. 2014;55:37-45.
-Asada S, Morita H, Watanabe A, Nakagawa K, Nagase S, Miyamoto M, et al. Indication and prognostic significance of programmed ventricular stimulation in asymptomatic patients with Brugada syndrome. Europace. 2020. DOI:10.1093/europace/euaa003.
-Sroubek J, Probst V, Mazzanti A, Delise P, Castro Hevia J, Ohkubo K, et al. Programmed ventricular stimulation for risk stratification in the Brugada syndrome. A pooled analysis. Circulation. 2016;133:622-630
-Paul M, Gerss J, Schulze-Bahr E, Wichter T, Vahlhaus C, Wilde A, et al. Role of programmed ventricular stimulation in patients with Brugada syndrome: a meta-analysis of worldwide published data. Eur Heart J. 2007;28:2126-33.
-Castro Hevia J. ¿Se deben implantar desfibriladores automáticos en pacientes portadores del síndrome de Brugada que hayan presentado síncope de dudosa causa arrítmica o estén asintomáticos?. Rev Cubana Cardiol Cir Cardiovasc. 2010;16:424-30.
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