Incidence, clinical implications and prognosis of atrial arrhythmias in Brugada syndrome

Abstract

Aims: This single-centre prospective study was designed to determine the incidence, therapeutic implications and prognosis of atrial arrhythmias (AA) in patients with Brugada syndrome (BS).

Methods and results: Fifty nine consecutive patients with BS and 31 age and gender-matched controls underwent an electrophysiological exploration and were followed-up during 34+/-13 months. The final AA incidence was 20% in BS patients vs 0% in controls (p < 0.01). Ventricular inducibility was significantly related to a history of AA (p = 0.02). The incidence of AA in patients with a spontaneous electrocardiogram of BS was 26% vs 10% in patients with a flecainide-induced electrocardiogram (p < 0.05). In patients with an indication of implantable cardioverter defibrillator (ICD), the incidence of AA reached 27% vs 13% in patients with BS but without ICD indication (p < 0.05). Inappropriate shocks due to AA episodes were observed in 14% of ICD patients vs 10.5% of appropriate shocks. Multivariate analysis identified the implantation of a single-chamber device as an independent predictive factor of inappropriate ICD discharges (p < 0.05).

Conclusion: BS patients exhibit an abnormally high proportion of AA. Our data strongly suggest a more advanced disease process in BS patients with spontaneous AA. Careful programming of single-chamber ICD should be recommended to avoid inappropriate discharges.