European Heart Journal Advance Access originally published online on May 5, 2007
European Heart Journal 2007 28(17):2126-2133; doi:10.1093/eurheartj/ehm116
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Role of programmed ventricular stimulation in patients with Brugada syndrome: a meta-analysis of worldwide published data
1 Department of Cardiology and Angiology, University Hospital of Muenster, Albert-Schweitzer-Str. 33, D-48149 Muenster, Germany
2 Leibniz-Institute for Arteriosclerosis Research at the University of Muenster, Muenster, Germany
3 Coordinating Centre for Clinical Trials, University Hospital of Muenster, Muenster, Germany
4 Experimental and Molecular Cardiology Group, Academic Medical Centre, Amsterdam, The Netherlands
Received 13 October 2006; revised 15 March 2007; accepted 22 March 2007; online publish-ahead-of-print 5 May 2007.
* Corresponding author. Tel: +49 251 83 47581; fax: +49 251 83 47864. E-mail address: mapaul{at}uni-muenster.de
Aims: Brugada syndrome (BS) is an ion channelopathy with the risk of sudden cardiac death. The role of programmed ventricular stimulation (PVS) in risk stratification has been controversially discussed. Therefore, we performed a meta-analysis on the prognostic role of PVS in BS.
Methods and results: A Medline® search until July 2006 documented 822 entries for BS. Only English publications with > 10 patients and a follow-up period were considered (n = 15). Patients [n = 1217; 974 males (80%)] were divided into three groups: survived sudden cardiac arrest (SCA) [n = 222 (18%)], syncope (Syncope) [n = 275 (23%)], and asymptomatic patients (Asympt) [n = 720 (59%)]. PVS was conducted in 1036 patients (85%). In 548 patients (53%), sustained ventricular tachyarrhythmias (VT) or ventricular fibrillation (VF) was inducible. During follow-up (34 ± 40 months), VT/VF occurred in 141 patients. SCA bore the highest chance for a VT/VF occurrence during follow-up [odds ratio (OR) 14.4 compared with asymptomatic patients; P < 0.0005]. However, except for one study, the OR for VT/VF during follow-up in relation to VT/VF inducibility was non-significant (OR 1.5; P = ns).
Conclusion: The main finding is that we were unable to identify a significant role of PVS with regard to arrhythmic events during follow-up in BS, thus questioning the role of PVS for risk stratification in patients with BS. Patients with BS and survived SCA show the highest chance for VT/VF occurrence during follow-up.
Key Words: Brugada syndrome • Programmed ventricular stimulation • Sudden cardiac death • Meta-analysis
These authors contributed equally to this manuscript.