Continuous Rhythm Monitoring With Implanted Loop Recorders in Children and Adolescents With Brugada Syndrome.

BACKGROUND

Young (<18 years of age) patients with Brugada syndrome (BrS) are often under-represented in BrS studies and their management, especially related to syncopal episodes, remains unclear.

OBJECTIVES

This study sought to describe the arrhythmia prevalence among young patients with BrS undergoing continuous rhythm monitoring by implantable loop recorder (ILR) and to assess the etiology behind syncope of undetermined origin.

METHODS

A total of 147 patients with BrS with ILR were enrolled in 12 international centers and divided into pediatric (age <12 years; n = 77, 52%) and adolescents (age 13-18 years; n = 70, 48%).

RESULTS

Mean age was 11.3 years, 53 patients (36.1%) were female, and 31 (21.1%) had spontaneous type 1 electrocardiograms. Over a median follow-up of 3.6 years (Q1-Q3: 1.6-4.8 years), an arrhythmic event was recorded in 33 patients (22.4%), mainly of nonventricular origin: 15 atrial (10.2%) and 16 bradyarrhythmic events (10.9%). Ventricular arrhythmias occurred in 4 patients, all with spontaneous BrS, and were fever-related in one-half. Among all patients with recurrence of syncope during follow-up, true arrhythmic syncope was documented in 5 (17.8%), and it was due to bradyarrhythmias or atrial arrhythmias in 3 cases (60%).

CONCLUSIONS

Continuous rhythm monitoring with ILRs in young patients with BrS detects a broad range of arrhythmias. Ventricular arrhythmias occur predominantly in patients with spontaneous type 1 electrocardiograms and during fever. Despite the young age, bradyarrhythmias and atrial arrhythmias are frequent and represent the cause of arrhythmic syncope in 60% of patients. Young patients with BrS with syncope of undetermined origin may benefit from ILR implant.

Informations de copyright

Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures This study was fully supported by a research grant of the Swiss National Science Foundation (PZ00P3_180055). Dr Özkartal has received research grants from Medtronic and Philips; and has received speaker fees from MicroPort CRM. Dr P. Brugada has received compensation for teaching purposes from Biotronik. Dr de Asmundis has received research grants on behalf of the center from Biotronik, Medtronic, Abbott, LivaNova, Boston Scientific, AtriCure, Philips, and Acutus Medical; and has received compensation for teaching purposes and proctoring from Medtronic, Abbott, Biotronik, LivaNova, Boston Scientific, AtriCure, Acutus Medical, and Daiichi-Sankyo. Dr Tondo has served on the Advisory Boards of Medtronic and Boston Scientific; and has received lecture and grant travel fees from Medtronic, Abbott Medical, Boston Scientific, and AtriCure. Dr Auricchio has served as a consultant to Boston Scientific, Cairdac, Corvia, MicroPort CRM, EPD-Philips, and Radcliffe Publisher; has received speaker fees from Boston Scientific, Medtronic, and MicroPort CRM; has participated in clinical trials sponsored by Boston Scientific, Medtronic, and EPD-Philips; and has intellectual properties with Boston Scientific, Biosense Webster, and MicroPort CRM. Dr Conte has received a research grant (PZ00P3_180055) from the Swiss National Science Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.