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. 2025 Sep 25.
doi: 10.1007/s00392-025-02738-w. Online ahead of print.

Predictive value of Shanghai score system in patients with drug-induced type 1 Brugada electrocardiographic pattern

Vincenzo Russo  1 , Alfredo Caturano  2   3 , Federico Migliore  4 , Federico Guerra  5 , Pietro Francia  6 , Martina Nesti  7 , Giulio Conte  8   9 , Alessandro Paoletti Perini  10 , Giuseppe Mascia  11 , Stefano Albani  12 , Procolo Marchese  13 , Vincenzo Ezio Santobuono  14 , Gregory Dendramis  15 , Andrea Rossi  7 , Andrea Ottonelli Ghidini  16 , Pasquale Notarstefano  17 , Luigi Sciarra  18 , Zefferino Palamà  19 , Enrico Baldi  20 , Roberto Floris  21 , Gerardo Nigro  22 ; IBRYD Study Group
Collaborators, Affiliations

Predictive value of Shanghai score system in patients with drug-induced type 1 Brugada electrocardiographic pattern

Vincenzo Russo et al. Clin Res Cardiol. .

Abstract

Background: The Shanghai score system was developed to enhance the risk stratification in Brugada Syndrome (BrS); however, its prognostic value in drug-induced type 1 BrS remains unclear.

Methods: This study involved 698 patients with drug-induced type 1 BrS, confirmed via pharmacologic challenge (flecainide or ajmaline), from 21 centers in Italy and Switzerland. Patients were classified according to the Shanghai score system: probable/definite BrS (score ≥ 3.5) and possible BrS (score < 3.5). The primary outcome was appropriate ICD therapy or sudden cardiac death (SCD)/sustained ventricular arrhythmias; the secondary outcome includes the identification of clinical predictors of primary outcome events. Kaplan-Meier and Cox regression analyses were used.

Results: Our study population included 239 patients (34.2%) with probable/definite BrS and 459 (65.8%) patients with possible BrS. During a median follow-up of 57.4 months, 20 patients (2.9%) experienced the primary outcome. Kaplan-Meier analysis revealed a significantly lower event rate in possible BrS (0.11% over 10 years) compared to probable/definite BrS (0.42%). SCN5A pathogenic variants were a significant predictor of primary endpoint in the possible BrS group (OR: 12.5).

Conclusions: Shanghai score system for BrS diagnosis may be useful as a tool for risk stratification of life-threatening arrhythmias among patients with drug-induced type I BrS ECG. Identifying the SCN5A mutations is of pivotal importance for refining the risk stratification.

Keywords: Brugada pattern; Brugada syndrome; Drug-induced type 1; Genetic testing; Programmed ventricular stimulation; Shanghai score; Syncope.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests.

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