Outcome after implantation of cardioverter defribrillator in patients with Brugada syndrome: A multicenter Israeli Study (ISRABRU)

Background: Many electrophysiologists recommend implantable cardioverter defibrillators for patients with Brugada syndrome who are cardiac arrest survivors or presumed at high risk of sudden death (patients with syncope or a familial history of sudden death or those with inducible ventricular fibrillation at electrophysiologic study). Objectives: To assess the efficacy and complications of ICD therapy in patients with Brugada syndrome. Methods: The indications, efficacy and complications of ICD therapy in all patients with Brugada syndrome who underwent ICD implantation in 12 Israeli centers between 1994 and 2007 were analyzed. Results: There were 59 patients (53 males, 89.8%) with a mean age of 44.1 years. At diagnosis 42 patients (71.2%) were symptomatic while 17 (28.8%) were asymptomatic. The indications for ICD implantation were a history of cardiac arrest (n=11, 18.6%), syncope (n=31, 52.5%), inducible VF in asymptomatic patients (n=14, 23.7%), and a family history of sudden death (n=3, 0.5%). The overall inducibility rates of VF were 89.2% and 93.3% among the symptomatic and asymptomatic patients, respectively (P=NS). During a follow-up of 4-160 (45±35) months, all patients (except one who died from cancer) are alive. Five patients (8.4%), all with a history of cardiac arrest, had appropriate ICD discharge. Conversely, none of the patients without prior cardiac arrest had appropriate device therapy during a 39 ± 30 month follow-up. Complications were encountered in 19 patients (32%). Inappropriate shocks occurred in 16 (27.1 %) due to lead failure/dislodgment (n=5), T wave oversensing (n=2), device failure (n=1), sinus rachycardia (n=4), and supraventricular tachycardia (n=4). One patient suffered a pneumothorax and another a brachial plexus injury during the implant procedure. One patient suffered a late (2 months) perforation of the right ventricle by the implanted lead. Eleven patients (18.6%) required a reintervention either for infection (n=1) or lead problems (n=10). Eight patients (13.5%) required psychiatric assistance due to complications related to the ICD (mostly in appropriate shocks in 7 patients). Conclusions: In this Israeli population with Brugada syndrome treated with ICD, appropriate device therapy was limited to cardiac arrest survivors while none of the other patients including those with syncope and/or inducible VF suffered an arrhythmic event. The overall complication rate was high.