Gender Differences in Patients with Brugada Syndrome and Arrhythmic Events: Data from a Survey on Arrhythmic Events in 678 Patients

Background

There is limited information on gender differences in patients with Brugada syndrome (BrS) who experienced arrhythmic events (AE).

Objectives

To compare clinical, electrocardiographic (ECG), electrophysiologic (EP) and genetic characteristics between males and females in a large cohort of BrS-patients with their first AE.

Methods

The multicenter Survey on AE in BrS (SABRUS) collected data on first AE in 678 BrS-patients including 619 (91.3%) males and 59 (8.7%) females aged 0.27 to 84 (mean 42.5±14.1) years at the time of the AE.

Results

Females and males presented their AE at similar ages (42.1±21.2 vs. 41.9±14 years, respectively); however, after excluding pediatric patients, females were older than males (49.5±14.4 vs. 43±12.7 years, respectively, P=0.001). Higher proportions of females were observed in the pediatric and elderly populations. In Asians, male/female ratio of AE was ≈9-fold higher compared to Caucasians. Females less frequently showed a spontaneous type-1 BrS-ECG (31% vs. 59%, P<0.001) or arrhythmia-inducibility at EP study (34% vs. 64%, P<0.001). An SCN5A mutation was more frequently found in females (47.6% vs. 27.8% in males, P=0.007). A high proportion of females (35% vs. 24% in males, P=0.25) underwent prophylactic ICD-implantation that subsequently proved to be justified (AE during follow up) despite not complying with current primary prevention guidelines.

Conclusions

This study confirms that female BrS-patients display less common risk factors for AE. It shows for the first time the complex relationship between gender distribution and patient ethnicity with the age at onset of AE as well as higher SCN5A mutation rates in females.