Tsukasa Kamakura1, Mitsuru Wada1, Ikutaro Nakajima1, Kohei Ishibashi1, Koji Miyamoto1, Hideo Okamura1, Takashi Noda1, Takeshi Aiba1, Hiroshi Takaki1, Satoshi Yasuda1, Hisao Ogawa1, Wataru Shimizu1, Takeru Makiyama1, Takeshi Kimura1, Shiro Kamakura2, Kengo Kusano1. 1. From the Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T. Kamakura, M.W., I.N., K.I., K.M., H.O., T.N., T.A., H.T., S.Y., H.O., W.S., S.K., K.K.); Division of Cardiology, Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T. Kamakura, T.M., T. Kimura); and Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.). 2. From the Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T. Kamakura, M.W., I.N., K.I., K.M., H.O., T.N., T.A., H.T., S.Y., H.O., W.S., S.K., K.K.); Division of Cardiology, Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T. Kamakura, T.M., T. Kimura); and Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.). kamakura@hsp.ncvc.go.jp.
Abstract
BACKGROUND: The clinical characteristics and prognosis of elderly patients with Brugada syndrome (BrS) are largely unknown. The purpose of this study was to evaluate the risks and benefits of implantable cardioverter defibrillator (ICD) in elderly patients with BrS based on a long follow-up. METHODS AND RESULTS: A total of 120 BrS patients with ICD (90 for aborted sudden cardiac arrest or syncope, mean age, 46.6±12.2 years; 50 with age ≥60 years at the last follow-up) were included in this study. During 102±68 months of follow-up, 31 patients (26%) experienced appropriate shocks. Age at the first attack of ventricular fibrillation (VF) was <70 years in all patients (mean, 45.0±12.1 years), the incidence of VF decreased with age, and VF did not recur after 70 years of age except in 2 patients with ischemic heart disease. Eleven of 28 patients with supraventricular tachycardia experienced inappropriate shocks. These inappropriate shocks increased with age and reached a peak in patients who were in their sixties. Lead failures occurred in later stages after implantation in 10 of 120 patients (8%). CONCLUSIONS: Long-term follow-up of high-risk BrS patients with ICD showed a low incidence of VF in those aged >70 years. Considering the increasing risk of inappropriate shocks because of the relatively late onset of supraventricular tachycardia and lead failures, avoidance of ICD implantation, or replacement may be considered in elderly BrS patients who remain free from VF until 70 years of age.
BACKGROUND: The clinical characteristics and prognosis of elderly patients with Brugada syndrome (BrS) are largely unknown. The purpose of this study was to evaluate the risks and benefits of implantable cardioverter defibrillator (ICD) in elderly patients with BrS based on a long follow-up. METHODS AND RESULTS: A total of 120 BrS patients with ICD (90 for aborted sudden cardiac arrest or syncope, mean age, 46.6±12.2 years; 50 with age ≥60 years at the last follow-up) were included in this study. During 102±68 months of follow-up, 31 patients (26%) experienced appropriate shocks. Age at the first attack of ventricular fibrillation (VF) was <70 years in all patients (mean, 45.0±12.1 years), the incidence of VF decreased with age, and VF did not recur after 70 years of age except in 2 patients with ischemic heart disease. Eleven of 28 patients with supraventricular tachycardia experienced inappropriate shocks. These inappropriate shocks increased with age and reached a peak in patients who were in their sixties. Lead failures occurred in later stages after implantation in 10 of 120 patients (8%). CONCLUSIONS: Long-term follow-up of high-risk BrS patients with ICD showed a low incidence of VF in those aged >70 years. Considering the increasing risk of inappropriate shocks because of the relatively late onset of supraventricular tachycardia and lead failures, avoidance of ICD implantation, or replacement may be considered in elderly BrS patients who remain free from VF until 70 years of age.