The Role of Electrophysiological Study in the Risk Stratification of Brugada Syndrome

George Bazoukis; Cheuk To Chung; Vassilios S Vassiliou; Dimitrios Sfairopoulos; Sharen Lee; Stamatis S Papadatos; Panagiotis Korantzopoulos; Athanasios Saplaouras; Konstantinos P Letsas; Tong Liu; Gary Tse

doi:10.1097/CRD.0000000000000561

The Role of Electrophysiological Study in the Risk Stratification of Brugada Syndrome

Cardiol Rev. 2023 May 2. doi: 10.1097/CRD.0000000000000561. Online ahead of print.

Authors

Affiliations

¹ From the Department of Cardiology, Larnaca General Hospital, Larnaca, Cyprus.
² Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus.
³ Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Hong Kong, China.
⁴ Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK, Norfolk and Norwich University Hospital and University of East Anglia, Norwich, UK.
⁵ First Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
⁶ Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong, China.
⁷ Department of Anatomy-Histology-Embryology, Faculty of Medicine, University of Ioannina, Ioannina, Greece.
⁸ Arrhythmia Unit, Laboratory of Cardiac Pacing and Electrophysiology, Onassis Cardiac Surgery Center, Athens, Greece.
⁹ Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.
¹⁰ Kent and Medway Medical School, Canterbury, Kent, United Kingdom; and.
¹¹ School of Nursing and Health Studies, Metropolitan University, Hong Kong, China.

PMID: 37126436
DOI: 10.1097/CRD.0000000000000561

Abstract

Brugada syndrome (BrS) is a complex arrhythmogenic disease associated with an increased risk of sudden cardiac death (SCD). The role of electrophysiological study (EPS) for risk stratification purposes of asymptomatic BrS patients remains still controversial. This study aims to summarize the existing data about the role of electrophysiological study for arrhythmic risk stratification of BrS patients without a prior history of aborted SCD or fatal arrhythmic event. Two independent investigators (G.B. and G.T.) performed a systematic search in the MedLine database and Cochrane library from their inception until April 2022 without any limitations. The reference lists of the relevant research studies as well as the relevant review studies and meta-analyses were manually searched. Nineteen studies were included in the final analysis. The included studies enrolled 6218 BrS patients (mean age: 46.9 years old, males: 76%) while 4265 (68.6%) patients underwent an EPS. The quantitative synthesis showed that a positive EPS study was significantly associated with arrhythmic events in BrS patients (RR, 1.74 [1.23-2.45]; P = 0.002; I2 = 63%]. By including the studies that provided data on the association of EPS with arrhythmic events during follow-up in patients without a prior history of aborted SCD or fatal arrhythmic event, the association between positive EPS study and future arrhythmic events remained significant (RR, 1.60 [1.08-2.36]; P = 0.02; I2 = 19%). In conclusion, EPS is a useful invasive tool for the risk stratification of BrS patients and can be used to identify the population of BrS patients who may be candidates for primary prevention of SCD with implantable cardioverter-defibrillator (ICD) implantation.