Clinical Profile, Treatment Strategies, and Outcomes of Filipino Adults with Brugada Pattern Electrocardiogram and Syndrome in a Tertiary Care Hospital in Manila, Philippines
Abstract
BACKGROUND: Brugada syndrome is an inheritable syndrome that carries an increased risk of sudden cardiac death. This study aims to delineate the natural history, clinical and electrophysiologic profile, treatment strategies, and outcomes of patients with Brugada pattern electrocardiogram (ECG) and Brugada syndrome in a tertiary care hospital in the Philippines.
METHODOLOGY: This is a retrospective observational study of patients diagnosed with Brugada pattern ECG and Brugada syndrome admitted in a single center from 2004 to 2019.
RESULTS: Twenty-three patients were included in the study. All patients were male. In both groups, the majority were nonsmokers (n = 13) and nonalcoholic beverage drinker (n = 14). In patients with Brugada pattern ECG, all presented as an incidental finding (n = 10; P < 0.001), whereas in Brugada syndrome, six patients presented with out-of-hospital resuscitated cardiac arrest (46.15%, P = 0.019). There were only three patients with a family history of sudden cardiac death. All patients had normal ejection fraction and sinus rhythm. Twenty-one patients had ST elevation (91.30%). Fourteen patients had spontaneous type 1 Brugada pattern ECG, whereas the rest were inducible to type 1 after flecainide test. Seven patients underwent implantable cardioverter-defibrillator implantation before discharge; one patient died at the time of diagnosis, and one had recurrent admission for arrhythmia. No single patient received medical management.
CONCLUSION: Clinical profile, ECG findings, and outcomes were not significantly different between the two groups of patients except for the clinical presentation upon diagnosis. Treatment strategies were guideline-directed.
KEYWORDS: Brugada pattern ECG, Brugada syndrome
- Dizon J. Brugada syndrome. Medscape. Updated January 9, 2017. https://emedicine.medscape.com/article/163751- overview#a2.
- Hu D, Barajas-Martinez H, Burasnikov E, et al. A mutation in the beta 3 subunit of the cardiac sodium channel associated with Brugada ECG phenotype [published online April 21, 2009]. Circ Cardiovasc Genet 2009;2(3):270–278. doi:10.1161/CIRCGENETICS.108.829192.
- Antzelevitch C, Yan G-X, Ackerman MJ, et al. J-wave syndromes expert consensus conference report: emerging concepts and gaps in knowledge. Europace 2017;19:665– 694 doi:10.1093/europace/euw235.
- Donohue D, Tehrani F, Jamehdor R, Lam C, Movahed MR. The prevalence of Brugada ECG in adult patients in a large university hospital in the Western United States. Am Heart Hosp J 2008;6(1):48–50.
- Priori SG, Wilde AA, Horie M, et al. HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes: document endorsed by HRS, EHRA, and APHRS in May 2013 and by ACCF, AHA, PACES, and AEPC in June 2013 [published online August 30, 2013]. Heart Rhythm 2013;10(12):1932–1963. doi:10.1016/j. hrthm.2013.05.014.
- Rashid A, et al. Clinical profile, risk stratification and treatment outcomes in Brugada syndrome. Int J Adv Sci Eng Technol 2017;5(3).
- Gervacio-Domingo GG, Aherrera J, Sy R, et al. Cardiac events occurred commonly among apparently healthy Filipinos with Brugada ECG pattern in the LIFECARE cohort. UP Philippine General Hospital. January 2018.
- Priori SG, Wilde AA, Horie M, et al. HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Heart Rhythm 2013;10(12):1932–1963. doi:10.1016/j.hrthm.2013.05.014 .
- Kayali S, Demir F. The effects of cigarette smoking on ventricular repolarization in adolescents. Einstein 2017;15(3):251–255. doi:10.1590/S1679- 45082017AO3945.
- Probst V, Veltmann C, Eckardt L, et al. Long-term prognosis of patients diagnosed with Brugada syndrome: results from the FINGER Brugada Syndrome Registry. Circulation 2010;121:635–643.
- Malik BR, Rudwan AMA, Abdelghani MS, et al. Brugada syndrome: clinical features, risk stratification, and management. Heart Views 2020;21:88–96.
- Gervacio-Domingo GG, Jocson G, Dans A. Frequency of cardiac events at four years among initially asymptomatic Filipinos with the Brugada type 1 electrocardiographic pattern. Am J Cardiol 2011;107:714–716.
- Murata K, Ueyama T, Tanaka T, Nose Y, Wada Y, Matsuzaki M. Right ventricular dysfunction in patients with Brugada like electrocardiography: a two dimensional strain imaging study. Cardiovasc Ultrasound 2011;9:30. https://doi.org/10.1186/1476-7120-9-30.
- Adler A, Rosso R, Chorin R, Havakuk O, Antzelevitch C, Viskin S. Risk stratification in Brugada syndrome clinical characteristics, electrocardiographic parameters and auxiliary testing. Heart Rhythm 2016;13(1):299–310.
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