Appropriate Primary Prophylactic Implantation of Defibrillator in Brugada Syndrome: Is There Difference between Patients from Western and Asian countries? 246 Patients with Arrhythmic Events

Anat Milman ¹ Antoine Andorin ² Jean-Baptiste Gourraud ² Frederic Sacher ³ Philippe Mabo ⁴ Sung-Hwan Kim ⁵ Shingo Maeda ⁶ Yoshihide Takahashi ⁶ Tsukasa Kamakura ⁷ Takeshi Aiba ⁷ Giulio Conte ⁸ Eran Leshem ^1,9 Michael Rahkovich ^1,10 Yuka Mizusawa ¹¹ Pieter Postema ¹¹ Elena Arbelo ¹² Zhengrong Huang ¹³ Isabelle Denjoy ¹⁴ Carla Giustetto ¹⁶ Carlo Napolitano ¹⁷ Aviram Hochstadt ¹⁹ Yoav Michowitz ¹ Ramon Brugada ²⁰ Jean Champagne ²¹ Leonardo Calo ²² Jacob Tfelt-Hansen ²³ Silvia Priori ^17,18 Masahiko Takagi ²⁴ Christian Veltmann ²⁵ Pietro Delise ²⁶ Domenico Corrado ²⁷ Elijah Behr ²⁸ Fiorenzo Gaita ¹⁶ Gan-Xin Yan ²⁹ Josep Brugada ¹² Antoine Leenhardt ^14,15 Arthur Wilde ¹¹ Pedro Brugada ⁸ Kengo Kusano ⁷ Kenzo Hirao ⁶ Gi-Byoung Nam ³⁰ Vincent Probst ² Bernard Belhassen ¹

¹Department of Cardiology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University
²Service de Cardiologie, L'institut du Thorax, CHU de Nantes
³Service de Cardiologie, LIRYC Institute, INSERM 1045, Bordeaux University Hospital
⁴Cardiology and Vascular Disease Division, Rennes University Health Centre
⁵Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea
⁶Heart Rhythm Center, Tokyo Medical and Dental University
⁷Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
⁸Heart Rhythm Management Center, UZ-VUB
⁹CardioVascular Institute, Beth Israel Deaconess Medical Center
¹⁰Arrhythmia Services, Sunnybrook Health Sciences Centre
¹¹Department of clinical and experimental Cardiology, Heart Center AMC, University of Amsterdam
¹²Cardiovascular Institute, Hospital Clínic Pediatric Arrhythmia Unit, Hospital Sant Joan de Déu University of Barcelona
¹³Department of Cardiology, The First Affiliated Hospital of Xiamen University
¹⁴Service de Cardiologie et CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat
¹⁵Service de Cardiologie, Université Paris Diderot, Sorbonne
¹⁶Division of Cardiology, University of Torino, Department of Medical Sciences, Città della Salute e della Scienza Hospital
¹⁷Molecular Cardiology, Institut d'Investigació Biomèdica Girona-IdIBGi
¹⁸Department of Molecular Medicin, University of Pavia
¹⁹Department of Internal Medicine J,, Tel Aviv Medical Center
²⁰Cardiovascular Genetics Center, Institut d'Investigació Biomèdica Girona-IdIBGi
²¹CardioVascular Institute, Quebec Heart and Lung Institute
²²Division of Cardiology, Policlinico Casilino
²³The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, and Department of Medicine and Surgery, University of Copenhagen
²⁴Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine
²⁵Rhythmology and Electrophysiology, Department of Cardiology, Hannover Medical School
²⁶Division of Cardiology, Hospital of Peschiera del Garda
²⁷Department of Cardiac, Thoracic and Vascular Sciences, University of Padova
²⁸Cardiovascular Sciences, St. George's University of London
²⁹Division of Cardiology, Lankenau Medical Center
³⁰Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine

Background:
There is limited information regarding characteristics of patients with Brugada syndrome (BrS) who received a prophylactically implantable cardioverter-defibrillator (ICD) that delivered appropriate therapy. We sought to compare patients’ characteristics and indications of prophylactic ICD implantation in a large cohort from Western and Asian countries who had an arrhythmic event after implantation.

Methods:
Patients were gathered from a multicenter survey involving 10 Western and 3 Asian countries. All received a primary prophylactic ICD that delivered >1 appropriate discharges.

Results:
There were 246 patients (224 males, 91%). Patients from Asian countries were all males, slightly older and more symptomatic at ICD implantation, and had less family history of sudden cardiac death (SCD). There were no differences between the two groups regarding presence of spontaneous type 1 ECG BrS, percentage of EPS done and positive EPS results. Conventional class II indications for prophylactic ICD implantation were met in 73.4% and 76.8% of patients from Western and Asian countries, respectively (P=N.S). Both groups did not differ in overall indications distribution (P=N.S).

Conclusions:
This study shows a few differences in clinical characteristics between patients from Asian and Western countries, who received appropriate ICD therapy for primary prevention. However, conventional class II indication for ICD was met in the same proportion of patients in both groups.