Stratification du risque de mort subite chez les patients présentant un syndrome de Brugada et un aspect de repolarisation précoce

Abstract : Introduction: Brugada syndrome (BrS) is an inherited arrhythmia syndrome with an increased risk of syncope and sudden death. The risk stratification of BrS patients remains challenging. An Early Repolarization pattern (ERP) has been suggested to increase the risk of ventricular arrhythmias. The aim of this study was to investigate the association between BrS and ERP with arrhythmic events in the largest cohort of BrS patients ever described. Methods: consecutive patients affected with BrS were recruited from 15 tertiary centers in France between 1994 and 2015. Data were prospectively collected with an average follow-up of 6.1± 4.6 years. ECGs were reviewed by 2 physicians blinded to clinical status. ERP was defined as a 0.1 mV J wave elevation in at least 2 inferior and/or lateral leads. Results: a total of 1613 patients (mean age 45±15 years; 1119 males, 69%) were enrolled in this study. Three hundred and twenty-three patients (20%) were symptomatic at baseline (66 (4%) aborted sudden cardiac death (SCD) or documented VT, 257 (16%) syncope). Four hundred and eleven patients (25%) presented a spontaneous type 1 ECG. Implantable cardiac defibrillator (ICD) was implanted in 477 patients (30%). At baseline, ERP has been found in 117 patients (7%): 76 patients (5%) presented QRS slurring, 33 (2%) QRS notching and 8 (0.5%) both. ERP were more frequent in male than in female (81% male, p=0.004). No significant difference was found in the age, family history of SCD or symptoms or spontaneous type 1 ECG. During follow-up of 6.1± 4.6 years, 84 of 1496 patients without ERP (6%) and 7 of the 117 patients with ERP (6%) underwent arrhythmic events (1 SCD, 5 appropriate ICD therapy and 1 ventricular arrhythmia). Patients with ERP had not a significantly higher rate of arrhythmic events than patients without ERP (HR: 1.16; 95% CI: 0.54-2.51; p= 0,7). Conclusion: in the largest cohort of BrS patients ever described, ERP does not seem to be a marker of arrhythmic event.
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Romain Tixier. Stratification du risque de mort subite chez les patients présentant un syndrome de Brugada et un aspect de repolarisation précoce. Médecine humaine et pathologie. 2018. ⟨dumas-02071738⟩

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