In 551 Brugada syndrome patients with an ICD followed for a median of 8.1 years, 11% had life-threatening arrhythmic events; ESC class IIa patients had a risk similar to secondary-prevention patients, and the BrS 5-year risk score (clinical plus genetic variables) at implant was associated with outcome, which may improve identification of patients who will benefit from ICD.
Eleven percent of ICD-implanted Brugada syndrome patients experienced life-threatening arrhythmic events (LAE) during long-term follow-up.
Patients with an ESC class IIa indication for ICD had a risk profile similar to that of patients implanted for secondary prevention.
CPG class IIa and class I patients had a similar rate of ICD shock at follow-up.
The BrS 5-year risk score, which includes clinical and genetic variables, was higher in patients with LAEs than in those without, in the whole cohort and in primary-prevention patients.
Quantifying the BrS arrhythmic risk score at the time of ICD implant may improve identification of patients who will benefit from the ICD during follow-up.
This study followed 551 people with Brugada syndrome, an inherited heart rhythm condition, who had received an implantable cardioverter-defibrillator (ICD). Over a median of about 8 years, 11% had a life-threatening arrhythmic event. The aim was to see whether current guideline-based reasons for implanting an ICD actually predict who will have such events later, and whether genetic information adds to the prediction. Patients who met the European guideline class IIa criteria had a risk similar to those who received an ICD after a prior arrhythmic event (secondary prevention). Class IIa and class I patients also had similar rates of ICD shocks. A recently developed 5-year risk score that combines clinical and genetic information was clearly higher at the time of implant in people who later had life-threatening events than in those who did not, both across all patients and among those who received an ICD for primary prevention. This research suggests that calculating this risk score when an ICD is implanted may help identify which patients are most likely to benefit from the device over time. The findings come from an observational cohort of people who already had ICDs, so they do not address people without devices.
Napolitano C, Pizzetti C, Kukavica D, Morini M, Ottaviano L, Giordano U, et al.. (2026). Long-term predictors of outcome in Brugada syndrome patients after implantable cardioverter-defibrillator implant.. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. https://doi.org/10.1093/europace/euag278