European Heart Journal Advance Access originally published online on October 19, 2007
European Heart Journal 2007 28(22):2819-2820; doi:10.1093/eurheartj/ehm457
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Long-term follow-up of primary prophylactic implantable cardioverter-defibrillator therapy in Brugada syndrome
Hôpital Pitié Salpêtrière
Institut de Cardiologie
Unité de Rythmologie
47-85 Boulevard de l'Hôpital
Paris
France
Hôpital Saint Camille
Service de Cardiologie
Bry sur marne
France
Hôpital Pitié Salpêtrière
Institut de Cardiologie
Unité de Rythmologie
47-85 Boulevard de l'Hôpital
Paris
France
Hôpital Pitié Salpêtrière
Institut de Cardiologie
Unité de Rythmologie
47-85 Boulevard de l'Hôpital
Paris
France
Hôpital Pitié Salpêtrière
Institut de Cardiologie
Unité de Rythmologie 47-85 Boulevard de l'Hôpital
Paris
France
Tel: +33 628464884 Fax: +33 49831009 E-mail address: aimebonny{at}yahoo.fr
In reference to the original and interesting study by Sarkozy et al.,1 we would like to point out the following comments regarding their inclusion criteria in this original study.
The study found the difference in appearance of coved-type ECG during follow-up of patients with baseline type II, type III, and normal ECG, respectively (56, 17, and 0%). Although type II and III are not diagnostic, these findings indicate that they do not have the same significance. Moreover, normal resting ECG in the so-called high-risk patients seems not to have dynamic changes, leading to diagnostic coved type. Thus, it is not clearly mentioned whether each patient with baseline normal resting ECG (nine patients) has the following risk factors: positive family history of sudden death (55% of all 47 studied), syncope prior to ICD (55%), both (30%), or inducible EP study (83%); considering that spontaneous coved type had not been seen during the follow-up period. Did they find SCN5A mutation or other mutation in these nine patients with normal resting ECG? What is the age distribution in the follow-up period? Knowing that if they were too young, BS phenotype might not have enough time to appear. None of them had appropriate shock. ICD implantation in patients with non-spontaneous coved-type pattern in conjunction with family history of sudden death and positive EP study is considered as class IIb.2 The consensus did not mention specifically the place of normal spontaneous ECG in the assessment of subjects with other high-risk factors of sudden death in Brugada syndrome. However, the authors' findings concerning baseline normal resting ECG seem to be confident with the highest negative predictive value as marker of sudden death. The authors' conclusion did not notice this fact, which is relevant from our point of view.
References
- Sarkozy A, Boussy T, Kourgiannides G, Chierchia G-B, Richter S, De Potter T, Geelen P, Wellens F, Spreeuwenberg MD, Brugada P. Long-term follow-up of primary prophylactic implantable cardioverter-defibrillator therapy in Brugada syndrome. Eur Heart J (2007) 28:334–344.
[Abstract/Free Full Text] - Antzelevitch C, Brugada P, Borggrefe M, Brugada J, Brugada R, Corrado D, Gussak I, LeMarec H, Nademanee K, Perez Riera AR, Shimizu W, Schulze-Bahr E, Tan H, Wilde A. Brugada syndrome: report of the Second Consensus Conference. Circulation (2005) 111:659–670.
[Abstract/Free Full Text]
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