Prevention of inappropriate ICD shocks in patients with Brugada syndrome

• Published in: Clinical research in cardiology 2010, Vol.99 (1), p.37-44
• Main Authors: Veltmann, Christian, Kuschyk, Juergen, Schimpf, Rainer, Streitner, Florian, Schoene, Nina, Borggrefe, Martin, Wolpert, Christian
• Format: Article
• Language: English
• Subjects: Adult; Brugada Syndrome - therapy; Cardiology; Death, Sudden, Cardiac - prevention & control; Defibrillators, Implantable - adverse effects; Equipment Failure; Female; Follow-Up Studies; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Original Paper; Prospective Studies; Tachycardia, Supraventricular - complications; Tachycardia, Supraventricular - etiology; Ventricular Fibrillation - etiology; Ventricular Fibrillation - therapy
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-009-0075-4

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.