Risk stratification of elderly patients with Brugada syndrome: Results from a large Japanese cohort of idiopathic ventricular fibrillation

Abstract

Background

Brugada syndrome (BrS) is an inherited cardiac channelopathy associated with a high risk of sudden cardiac death (SCD) due to ventricular fibrillation (VF). Although implantable cardioverter-defibrillators (ICDs) are the primary therapy for SCD prevention, the risk stratification of elderly patients with BrS remains unclear. This study aimed to evaluate the incidence and risk factors of life-threatening arrhythmias in elderly patients with BrS.

Methods

We analyzed 523 patients with BrS (mean age 51 ± 13 years, 497 men) enrolled in the multicenter prospective Japan Idiopathic Ventricular Fibrillation Study. Patients were categorized into the elderly (>60 years, n = 150) and nonelderly (≤60 years, n = 373) groups. Clinical characteristics, programmed electrical stimulation (PES) results, and outcomes, including cardiac events (CEs: VF, fast ventricular tachycardia, or SCD), were compared. Statistical analyses were performed using Kaplan–Meier curves and Cox proportional hazard models.

Results

During a mean follow-up of 106 ± 62 months, 59 patients (11%) experienced CE. The annual CE incidence was lower in the elderly group than in the nonelderly group (0.7% vs. 1.5%, p = 0.016). History of VF independently predicted CE occurrence in elderly patients (hazard ratio: 23.5, p < 0.001). Asymptomatic elderly patients exhibited a negligible risk of CE. PES did not predict CE occurrence in the elderly group.

Conclusions

Elderly patients with BrS have a better prognosis than nonelderly patients, particularly if they are asymptomatic. A history of VF is a key risk factor for life-threatening arrhythmias in elderly patients with BrS.