High-risk atrioventricular block in Brugada syndrome patients with a history of syncope

Tsukasa Kamakura, Frederic Sacher, Katsuhiko Katayama, Nobuhiko Ueda, Kenzaburo Nakajima, Mitsuru Wada, Kenichiro Yamagata, Kohei Ishibashi, Yuko Inoue, Koji Miyamoto, Satoshi Nagase, Takashi Noda, Takeshi Aiba, Yosuke Nakatani, F. Daniel Ramirez, Clémentine André, Takashi Nakashima, Philipp Krisai, Takamitsu Takagi, Romain TixierRemi Chauvel, Ghassen Cheniti, Josselin Duchateau, Thomas Pambrun, Nicolas Derval, Mélèze Hocini, Pierre Jais, Michel Haïssaguerre, Shiro Kamakura, Kengo Kusano

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

Abstract

Background: Determining the etiology of syncope is challenging in Brugada syndrome (BrS) patients. Implantable cardioverter defibrillator placement is recommended in BrS patients who are presumed to have arrhythmic syncope. However, arrhythmic syncope in BrS patients can occur in the setting of atrioventricular block (AVB), which should be managed by cardiac pacing. The clinical characteristics of BrS patients with high-risk AVB remain unknown. Methods: This study included 223 BrS patients with a history of syncope from two centers. The clinical characteristics of patients with high-risk AVB (Mobitz type II second-degree AVB, high-degree AVB, or third-degree AVB) were investigated. Results: During the 99 ± 78 months of follow-up, we identified six BrS patients (2.7%) with high-risk AVB. Three of the six patients (50%) with AVB presented with syncope associated with prodromes or specific triggers. Four patients (67%) were found to have paroxysmal third-degree AVB during the initial evaluation for BrS and syncope, while two patients developed third-degree AVB during the follow-up period. The incidence of first-degree AVB was significantly higher in AVB patients than in non-AVB patients (83% vs. 15%; p =.0005). There was no significant difference in the incidence of ventricular fibrillation between AVB and non-AVB patients (AVB [17%], non-AVB [12%]; p =.56). Conclusion: High-risk AVB can occur in BrS patients with various clinical presentations. Although rare, the incidence is worth considering, especially in BrS patients with first-degree AVB.

Original languageEnglish
Pages (from-to)772-781
Number of pages10
JournalJournal of Cardiovascular Electrophysiology
Volume32
Issue number3
DOIs
Publication statusPublished - 2021 Mar

Keywords

  • atrioventricular block
  • Brugada syndrome
  • implantable cardioverter defibrillator
  • syncope
  • ventricular fibrillation

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