215 Evaluation of Syncope in Brugada Syndrome: The Effect on Outcome

Evaluation of Syncope in Brugada SyndromeThe Effect on Outcome Risk stratification in pts with Brugada syndrome (BS) is difficult. The report from the 2nd Consensus Committee on BS suggests that all pts with syncope without a “clear extracardiac cause” should have an implantable cardioverter-defibrillator (ICD). However a clear cause for syncope may be difficult to prove.MethodsAll pts diagnosed with BS at Bordeaux CHU between 1999 and 2009 have been enrolled in a prospective registry. All patients with syncope were enrolled in the present study (Group 1 without and Group 2 with a “clear extracardiac cause” of syncope). Patients were followed in the clinic or by phone annually unless there was an event.ResultsOf 185 pts with BS, 49 (39 male, 47 ±12yo) had at least one syncope. All 27 pts in group 1 received an ICD. Of the 22 pts in group 2, 4 received an implantable loop recorder [MJW1] (ILR) and 1 patient received an ICD after positive EP study.With a mean follow-up of 53 ±38 months, 19 pts were asymptomatic, 5 had appropriate ICD therapy, 2 patients had further syncopal events not associated with cardiac arrhythmia and 1 pt died of a non cardiac cause in group 1. In group 2, 14pts were asymptomatic, 5 had recurrent atypical syncopal events (without arrhythmia shown by ILR in 3 pts), 2 experienced atypical chest pain and 1 died of drug abuse.ConclusionsDiagnosis of syncope is difficult, and 7% of BS pts presenting with syncope without a clear cardiac cause will have further events without cardiac arrhythmia. Better evaluation of syncope is required to spare pts unnecessary ICDs.group 1 27 patients syncope without a clear extracardiac causegroup 2 22 patients syncope with a clear extracardiac causepgender (male)21 (80.8%)18 (78.3%)0.83age (years old)48 (+/- 12.2)45 (+/- 11)0.39follow-up (months)53 (+/- 36.1)52 (+/- 42.3)0.90spontaneous type 1 ECG21 (80.8%)13 (56.5%)0.07EP Study:– positive8 (29.7%)1 (4.5%)0.06– negative13 (48%)17 (77.3%)– not done6 (22.3%)4 (18.2%)circunstances of diagnosis:– unexpected finding4 (14.8%)7 (31.8%)0.43– familial assessment2 (7.4%)2 (9.1%)– syncope21 (77.8%)13 (59.1%