Role of subcutaneous implantable loop recorder for the diagnosis of arrhythmias in Brugada syndrome: A United Kingdom single-center experience

• Published in: Heart rhythm Vol. 19; no. 1; pp. 70 - 78
• Main Authors: Scrocco, Chiara, Ben-Haim, Yael, Devine, Brian, Tome-Esteban, Maite, Papadakis, Michael, Sharma, Sanjay, Macfarlane, Peter W., Behr, Elijah R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2022
• Subjects: Adult; Brugada syndrome; Brugada Syndrome - physiopathology; Electrocardiography; Electrocardiography, Ambulatory - instrumentation; Female; Humans; Implantable loop recorder; Male; Middle Aged; Recurrence; Retrospective Studies; Sudden death; Syncope - diagnosis; Syncope - physiopathology; Ventricular arrhythmia; Electrocardiography; Ventricular arrhythmia; Brugada syndrome; Sudden death; Implantable loop recorder
• ISSN: 1547-5271; 1556-3871; 1556-3871
• DOI: 10.1016/j.hrthm.2021.08.034

Experience with implantable loop recorders (ILRs) in Brugada syndrome (BrS) is limited. The purpose of this study was to evaluate the indications and yield of ILR monitoring in a single-center BrS registry. Demographic, clinical and follow-up data of BrS patients with ILR were collected. Of 415 BrS patients recruited consecutively, 50 (12%) received an ILR (58% male). Mean age at ILR implantation was 44 ± 15 years. Thirty-one (62%) had experienced syncopal or presyncopal episodes, and 23 (46%) had palpitations. During median follow-up of 28 months (range 1–68), actionable events were detected in 11 subjects (22%); 7 had recurrences of syncope/presyncope, with 4 showing defects in sinus node function or atrioventricular conduction. New supraventricular tachyarrhythmias were recorded in 6 subjects; a run of fast nonsustained ventricular tachycardia was detected in 1 patient. Patients implanted with an ILR were less likely to show a spontaneous type 1 pattern or depolarization electrocardiographic (ECG) abnormalities compared to those receiving a primary prevention implantable-cardioverter defibrillator. Age at implantation, gender, Shanghai score, and ECG parameters did not differ between subjects with and those without actionable events. ILR-related complications occurred in 3 cases (6%). In a large cohort of BrS patients, continuous ILR monitoring yielded a diagnosis of tachy- or bradyarrhythmic episodes in 22% of cases. Recurrences of syncope were associated with bradyarrhythmic events. Use of ILR can be helpful in guiding the management of low-/intermediate-risk BrS patients and ascertaining the cause of unexplained syncope. [Display omitted]