TY - JOUR
T1 - Arrhythmia detection using an implantable loop recorder after a negative electrophysiology study in Brugada syndrome
T2 - Observations from a multicenter international registry
AU - García-Izquierdo, Eusebio
AU - Scrocco, Chiara
AU - Palacios-Rubio, Julián
AU - Assaf, Amira
AU - Ripoll-Vera, Tomás
AU - Hernandez-Betancor, Iván
AU - Ramos-Ruiz, Pablo
AU - Melero-Pita, Antonio
AU - Segura-Domínguez, Melodie
AU - Jiménez-Sánchez, Diego
AU - Castro-Urda, Victor
AU - Toquero-Ramos, Jorge
AU - Yap, Sing Chien
AU - Behr, Elijah R.
AU - Fernández-Lozano, Ignacio
N1 - Publisher Copyright:
© 2024 Heart Rhythm Society
PY - 2024/8
Y1 - 2024/8
N2 - Background: Risk stratification in Brugada syndrome (BrS) remains controversial. In this respect, the role of the electrophysiology study (EPS) has been a subject of debate. In some centers, it is common practice to use an implantable loop recorder (ILR) after a negative EPS to help in risk stratification. However, the diagnostic value of this approach has never been specifically addressed. Objective: The aim of this study was to describe the baseline characteristics and the main findings of a diagnostic workup strategy with an ILR after a negative EPS in BrS. Methods: We conducted a retrospective international registry including patients with BrS and negative EPS (ie, noninducible ventricular tachycardia or ventricular fibrillation) before ILR monitoring. Results: The study included 65 patients from 8 referral hospitals in The Netherlands, Spain, and the United Kingdom (mean age, 39 ± 16 years; 72% male). The main indication for ILR monitoring was unexplained syncope/presyncope (66.2%). During a median follow-up of 39.0 months (Q1 25.0–Q3 47.6 months), 18 patients (27.7%) experienced 21 arrhythmic events (AEs). None of the patients died during follow-up. Bradyarrhythmias were the most common finding (47.6%), followed by atrial tachyarrhythmias (38.1%). Only 3 patients presented with ventricular arrhythmias. AEs were considered incidental in 12 patients (66.7%). In 11 patients (61.1%), AEs led to specific changes in treatment. Conclusion: The use of ILR after a negative EPS in BrS is a safe strategy that reflected the high negative predictive value of EPS for ventricular arrhythmia in this syndrome. In addition, it allowed the detection of AEs in a significant proportion of patients, with therapeutic implications in most of them.
AB - Background: Risk stratification in Brugada syndrome (BrS) remains controversial. In this respect, the role of the electrophysiology study (EPS) has been a subject of debate. In some centers, it is common practice to use an implantable loop recorder (ILR) after a negative EPS to help in risk stratification. However, the diagnostic value of this approach has never been specifically addressed. Objective: The aim of this study was to describe the baseline characteristics and the main findings of a diagnostic workup strategy with an ILR after a negative EPS in BrS. Methods: We conducted a retrospective international registry including patients with BrS and negative EPS (ie, noninducible ventricular tachycardia or ventricular fibrillation) before ILR monitoring. Results: The study included 65 patients from 8 referral hospitals in The Netherlands, Spain, and the United Kingdom (mean age, 39 ± 16 years; 72% male). The main indication for ILR monitoring was unexplained syncope/presyncope (66.2%). During a median follow-up of 39.0 months (Q1 25.0–Q3 47.6 months), 18 patients (27.7%) experienced 21 arrhythmic events (AEs). None of the patients died during follow-up. Bradyarrhythmias were the most common finding (47.6%), followed by atrial tachyarrhythmias (38.1%). Only 3 patients presented with ventricular arrhythmias. AEs were considered incidental in 12 patients (66.7%). In 11 patients (61.1%), AEs led to specific changes in treatment. Conclusion: The use of ILR after a negative EPS in BrS is a safe strategy that reflected the high negative predictive value of EPS for ventricular arrhythmia in this syndrome. In addition, it allowed the detection of AEs in a significant proportion of patients, with therapeutic implications in most of them.
UR - https://www.scopus.com/pages/publications/85189149277
U2 - 10.1016/j.hrthm.2024.03.003
DO - 10.1016/j.hrthm.2024.03.003
M3 - Article
C2 - 38458509
AN - SCOPUS:85189149277
SN - 1547-5271
VL - 21
SP - 1317
EP - 1324
JO - Heart Rhythm
JF - Heart Rhythm
IS - 8
ER -