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Prevention of inappropriate ICD shocks in patients with Brugada syndrome

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Abstract

Background

In Brugada syndrome implantable cardioverter defibrillator (ICD) therapy is associated with a high rate of inappropriate therapies, mainly due to supraventricular tachyarrhythmias (SVT) (2.7–14.1%/year). Aim of the present study was to evaluate a single ventricular fibrillation (VF) detection zone with a high cut-off rate with respect to prevention of inappropriate ICD shock due to SVT and safety of this programming.

Methods

Sixty-one consecutive patients (mean age 42.6 ± 12.9 years; 41 males) diagnosed with Brugada syndrome and implanted with an ICD were included. ICDs were prospectively programmed with a single VF detection zone and a cut-off rate of 222 beats/minute (bpm). A maximum of six shocks with the maximal shock energy were programmed. The minimal follow-up was 1 year.

Results

During a follow-up of 47.6 ± 23.1 months seven patients (2.91%/year) received appropriate ICD shocks. No patient suffered from syncope or died. Five patients (2.07%/year) received inappropriate ICD shocks: four patients due to T-wave oversensing and only one patient (0.4%/year) due to SVT (atrial fibrillation with a ventricular rate of >222 bpm).

Conclusions

Programming of a single, high-rate VF zone in patients with Brugada syndrome and an implanted defibrillator is safe. Such programming may be associated with reduced inappropriate defibrillator discharges. A single detection zone with a high VF cut-off rate can be recommended in patients with Brugada syndrome.

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References

  1. Allocca G, Proclemer A, Nucifora G, Dall’armellina E, Rebellato L (2008) Monomorphic ventricular tachycardia in ‘Brugada syndrome’: clinical case and literature review. J Cardiovasc Med (Hagerstown) 9:842–846

    Google Scholar 

  2. Alter P, Waldhans S, Plachta E, Moosdorf R, Grimm W (2005) Complications of implantable cardioverter defibrillator therapy in 440 consecutive patients. Pacing Clin Electrophysiol 28:926–932

    Article  PubMed  Google Scholar 

  3. 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 (2005) Brugada syndrome: report of the second consensus conference. Heart Rhythm 2:429–440

    Article  PubMed  Google Scholar 

  4. Bertomeu-Gonzalez V, Ruiz-Granell R, Garcia-Civera R, Morell-Cabedo S, Ferrero A (2006) Syncopal monomorphic ventricular tachycardia with pleomorphism, sensitive to antitachycardia pacing in a patient with Brugada syndrome. Europace 8:1048–1050

    Article  PubMed  Google Scholar 

  5. Bordachar P, Reuter S, Garrigue S, Cai X, Hocini M, Jais P, Haissaguerre M, Clementy J (2004) Incidence, clinical implications and prognosis of atrial arrhythmias in Brugada syndrome. Eur Heart J 25:879–884

    Article  PubMed  Google Scholar 

  6. Brugada J, Brugada R, Brugada P (2003) Determinants of sudden cardiac death in individuals with the electrocardiographic pattern of Brugada syndrome and no previous cardiac arrest. Circulation 108:3092–3096

    Article  PubMed  Google Scholar 

  7. Brugada P, Brugada J (1992) Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol 20:1391–1396

    Article  CAS  PubMed  Google Scholar 

  8. Carroll DL, Hamilton GA (2005) Quality of life in implanted cardioverter defibrillator recipients: the impact of a device shock. Heart Lung 34:169–178

    Article  PubMed  Google Scholar 

  9. Catanchin A, Anderson L, Jones S, Ward D (2008) When life-saving devices terminate life. J Cardiovasc Electrophysiol 19:316–318

    Article  PubMed  Google Scholar 

  10. Demaso DR, Neto LB, Hirshberg J (2009) Psychological and quality-of-life issues in the young patient with an implantable cardioverter-defibrillator. Heart Rhythm 6(1):130–132

    Article  PubMed  Google Scholar 

  11. Diez C, Hofmann HS, Borgermann J (2009) Atrial and ventricular lead insulation defects with resulting inappropriate shocks and end-of-life of the ICD pulse generator in a young bodybuilder with congenital long-QT-syndrome. Clin Res Cardiol 98:16–18

    Article  PubMed  Google Scholar 

  12. Dinckal MH, Davutoglu V, Akdemir I, Soydinc S, Kirilmaz A, Aksoy M (2003) Incessant monomorphic ventricular tachycardia during febrile illness in a patient with Brugada syndrome: fatal electrical storm. Europace 5:257–261

    Article  CAS  PubMed  Google Scholar 

  13. Eckardt L, Kirchhof P, Loh P, Schulze-Bahr E, Johna R, Wichter T, Breithardt G, Haverkamp W, Borggrefe M (2001) Brugada syndrome and supraventricular tachyarrhythmias: a novel association? J Cardiovasc Electrophysiol 12:680–685

    Article  CAS  PubMed  Google Scholar 

  14. Eckardt L, Probst V, Smits JP, Bahr ES, Wolpert C, Schimpf R, Wichter T, Boisseau P, Heinecke A, Breithardt G, Borggrefe M, LeMarec H, Bocker D, Wilde AA (2005) Long-term prognosis of individuals with right precordial ST-segment-elevation Brugada syndrome. Circulation 111:257–263

    Article  PubMed  Google Scholar 

  15. Francis J, Antzelevitch C (2008) Atrial fibrillation and Brugada syndrome. J Am Coll Cardiol 51:1149–1153

    Article  PubMed  Google Scholar 

  16. Guidant Inc. SP, Mn (2000) Technical manual Guidant ICD

  17. Hauck M, Bauer A, Voss F, Weretka S, Katus HA, Becker R (2009) “Home monitoring” for early detection of implantable cardioverter-defibrillator failure: a single-center prospective observational study. Clin Res Cardiol 98(1):19–24

    Article  PubMed  Google Scholar 

  18. Kharazi A, Emkanjoo Z, Alizadeh A, Nikoo MH, Jorat MV, Sadr-Ameli MA (2007) Mid-term follow-up of patients with Brugada syndrome following a cardioverter defibrillator implantation: a single center experience. Indian Pacing Electrophysiol J 7:33–39

    CAS  PubMed  Google Scholar 

  19. Kusano KF, Taniyama M, Nakamura K, Miura D, Banba K, Nagase S, Morita H, Nishii N, Watanabe A, Tada T, Murakami M, Miyaji K, Hiramatsu S, Nakagawa K, Tanaka M, Miura A, Kimura H, Fuke S, Sumita W, Sakuragi S, Urakawa S, Iwasaki J, Ohe T (2008) Atrial fibrillation in patients with Brugada syndrome relationships of gene mutation, electrophysiology, and clinical backgrounds. J Am Coll Cardiol 51:1169–1175

    Article  PubMed  Google Scholar 

  20. Mansour F, Thibault B, Dubuc M, Guerra PG, Macle L, Brugada R, Roy D, Talajic M, Khairy P (2007) Shocking truths about implantable cardioverter defibrillator monitoring zones. Pacing Clin Electrophysiol 30:1146–1148

    Article  PubMed  Google Scholar 

  21. Morita H, Kusano-Fukushima K, Nagase S, Fujimoto Y, Hisamatsu K, Fujio H, Haraoka K, Kobayashi M, Morita ST, Nakamura K, Emori T, Matsubara H, Hina K, Kita T, Fukatani M, Ohe T (2002) Atrial fibrillation and atrial vulnerability in patients with Brugada syndrome. J Am Coll Cardiol 40:1437–1444

    Article  PubMed  Google Scholar 

  22. Priori SG, Napolitano C, Gasparini M, Pappone C, Della Bella P, Giordano U, Bloise R, Giustetto C, De Nardis R, Grillo M, Ronchetti E, Faggiano G, Nastoli J (2002) Natural history of Brugada syndrome: insights for risk stratification and management. Circulation 105:1342–1347

    Article  PubMed  Google Scholar 

  23. Probst V, Evain S, Gournay V, Marie A, Schott JJ, Boisseau P, LEM H (2006) Monomorphic ventricular tachycardia due to Brugada syndrome successfully treated by hydroquinidine therapy in a 3-year-old child. J Cardiovasc Electrophysiol 17:97–100

    Article  PubMed  Google Scholar 

  24. Sacher F, Probst V, Bessouet M, Wright M, Maluski A, Abbey S, Bordachar P, Deplagne A, Ploux S, Lande G, Jais P, Hocini M, Haissaguerre M, Le Marec H, Clementy J (2009) Remote implantable cardioverter defibrillator monitoring in a Brugada syndrome population. Europace 11(4):489–494

    Article  PubMed  Google Scholar 

  25. Sacher F, Probst V, Iesaka Y, Jacon P, Laborderie J, Mizon-Gerard F, Mabo P, Reuter S, Lamaison D, Takahashi Y, O’Neill MD, Garrigue S, Pierre B, Jais P, Pasquie JL, Hocini M, Salvador-Mazenq M, Nogami A, Amiel A, Defaye P, Bordachar P, Boveda S, Maury P, Klug D, Babuty D, Haissaguerre M, Mansourati J, Clementy J, Le Marec H (2006) Outcome after implantation of a cardioverter-defibrillator in patients with Brugada syndrome: a multicenter study. Circulation 114:2317–2324

    Article  PubMed  Google Scholar 

  26. Sarkozy A, Boussy T, Kourgiannides G, Chierchia GB, Richter S, De Potter T, Geelen P, Wellens F, Spreeuwenberg MD, Brugada P (2007) Long-term follow-up of primary prophylactic implantable cardioverter-defibrillator therapy in Brugada syndrome. Eur Heart J 28:334–344

    Article  PubMed  Google Scholar 

  27. Schimpf R, Giustetto C, Eckardt L, Veltmann C, Wolpert C, Gaita F, Breithardt G, Borggrefe M (2008) Prevalence of supraventricular tachyarrhythmias in a cohort of 115 patients with Brugada syndrome. Ann Noninvasive Electrocardiol 13:266–269

    Article  PubMed  Google Scholar 

  28. Schron EB, Exner DV, Yao Q, Jenkins LS, Steinberg JS, Cook JR, Kutalek SP, Friedman PL, Bubien RS, Page RL, Powell J (2002) Quality of life in the antiarrhythmics versus implantable defibrillators trial: impact of therapy and influence of adverse symptoms and defibrillator shocks. Circulation 105:589–594

    Article  PubMed  Google Scholar 

  29. Sears SF, Todaro JF, Urizar G, Lewis TS, Sirois B, Wallace R, Sotile W, Curtis AB, Conti JB (2000) Assessing the psychosocial impact of the ICD: a national survey of implantable cardioverter defibrillator health care providers. Pacing Clin Electrophysiol 23:939–945

    Article  CAS  PubMed  Google Scholar 

  30. Veltmann C, Borggrefe M, Schimpf R, Wolpert C (2007) Fatal inappropriate ICD shock. J Cardiovasc Electrophysiol 18:326–328

    Article  PubMed  Google Scholar 

  31. Wilde AA, Antzelevitch C, Borggrefe M, Brugada J, Brugada R, Brugada P, Corrado D, Hauer RN, Kass RS, Nademanee K, Priori SG, Towbin JA (2002) Proposed diagnostic criteria for the Brugada syndrome. Eur Heart J 23:1648–1654

    CAS  PubMed  Google Scholar 

  32. Wolpert C, Jung W, Spehl S, Korte T, Luderitz B (1998) Case report: inappropriate discharge of an implantable cardioverter-defibrillator caused by the combined count criterion. J Interv Card Electrophysiol 2:53–56

    Article  CAS  PubMed  Google Scholar 

  33. Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC Jr, Jacobs AK, Adams CD, Antman EM, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Blanc JJ, Budaj A, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL (2006) ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 48:e247–e346

    Article  PubMed  Google Scholar 

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Correspondence to Christian Veltmann.

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C. Veltmann and J. Kuschyk contributed equally to the work.

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Veltmann, C., Kuschyk, J., Schimpf, R. et al. Prevention of inappropriate ICD shocks in patients with Brugada syndrome. Clin Res Cardiol 99, 37–44 (2010). https://doi.org/10.1007/s00392-009-0075-4

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  • DOI: https://doi.org/10.1007/s00392-009-0075-4

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