Spontaneous type 1 ECG and arrhythmic risk in Brugada syndrome: A meta-analysis of adjusted time-to-event data

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2 Pub Date : 2025-02-01 DOI:10.1016/j.hroo.2024.11.022

Sotirios Chiotis MD , Luigi Pannone MD , Ioannis Doundoulakis MD, PhD , Domenico Giovanni Della Rocca MD, PhD , Stefanos Zafeiropoulos MD, PhD , Antonio Sorgente MD, PhD , Lorenzo Marcon MD , Giampaolo Vetta MD , Leonidas Koliastasis MD, PhD , Alvise Del Monte MD , Kazutaka Nakasone MD, PhD , Stavritsa T. Varvara MD , Mark La Meir MD, PhD , Ingrid Overeinder MD , Gezim Bala MD, PhD , Alexandre Almorad MD , Erwin Ströker MD, PhD , Juan Sieira MD, PhD , Dimitrios Tsiachris MD, PhD , Vasileios Vassilikos MD, PhD , Carlo de Asmundis MD, PhD, FHRS

{"title":"Spontaneous type 1 ECG and arrhythmic risk in Brugada syndrome: A meta-analysis of adjusted time-to-event data","authors":"Sotirios Chiotis MD , Luigi Pannone MD , Ioannis Doundoulakis MD, PhD , Domenico Giovanni Della Rocca MD, PhD , Stefanos Zafeiropoulos MD, PhD , Antonio Sorgente MD, PhD , Lorenzo Marcon MD , Giampaolo Vetta MD , Leonidas Koliastasis MD, PhD , Alvise Del Monte MD , Kazutaka Nakasone MD, PhD , Stavritsa T. Varvara MD , Mark La Meir MD, PhD , Ingrid Overeinder MD , Gezim Bala MD, PhD , Alexandre Almorad MD , Erwin Ströker MD, PhD , Juan Sieira MD, PhD , Dimitrios Tsiachris MD, PhD , Vasileios Vassilikos MD, PhD , Carlo de Asmundis MD, PhD, FHRS","doi":"10.1016/j.hroo.2024.11.022","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Brugada syndrome (BrS) is associated with an increased risk of major arrhythmic events (MAEs), particularly in patients with a spontaneous type 1 electrocardiographic (ECG) pattern.</div></div><div><h3>Objective</h3><div>Because previous meta-analyses used mainly crude or unadjusted data from observational studies, we conducted an updated meta-analysis on the prognostic role of spontaneous type 1 ECG in BrS patients combining adjusted and unadjusted data separately.</div></div><div><h3>Methods</h3><div>We conducted a systematic search of PubMed and Cochrane Central Register of Controlled Trials from inception to May 2024. Studies providing hazard ratios for MAEs associated with spontaneous type 1 ECG in BrS patients were included.</div></div><div><h3>Results</h3><div>Eighteen studies comprising 7238 patients were included, with 10 providing adjusted and 17 providing unadjusted data. Separate pooled analyses using a random-effects model demonstrated a significantly increased risk of MAEs in BrS patients with spontaneous type 1 ECG compared with those without, with a pooled adjusted hazard ratio (aHR) of 2.05 (95% CI 1.38–3.03) and an unadjusted hazard ratio of 2.97 (95% CI 2.04–4.34). Subgroup analysis revealed higher risks in studies with non-Asian populations and those including patients with no history of aborted cardiac arrest (aHR 2.36, 95% CI 1.35–4.11; and aHR 3.56, 95% CI 2.35–5.41, respectively) and a persistent significant risk in studies accounting for syncope as a covariate (aHR 2.01, 95% CI 1.24–3.27).</div></div><div><h3>Conclusion</h3><div>Our analysis indicates that patients with BrS and spontaneous type 1 ECG are at higher risk of MAEs. This is consistent across various subgroups, including asymptomatic individuals.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 2","pages":"Pages 195-203"},"PeriodicalIF":2.5000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart Rhythm O2","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666501824004094","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Brugada syndrome (BrS) is associated with an increased risk of major arrhythmic events (MAEs), particularly in patients with a spontaneous type 1 electrocardiographic (ECG) pattern.

Objective

Because previous meta-analyses used mainly crude or unadjusted data from observational studies, we conducted an updated meta-analysis on the prognostic role of spontaneous type 1 ECG in BrS patients combining adjusted and unadjusted data separately.

Methods

We conducted a systematic search of PubMed and Cochrane Central Register of Controlled Trials from inception to May 2024. Studies providing hazard ratios for MAEs associated with spontaneous type 1 ECG in BrS patients were included.

Results

Eighteen studies comprising 7238 patients were included, with 10 providing adjusted and 17 providing unadjusted data. Separate pooled analyses using a random-effects model demonstrated a significantly increased risk of MAEs in BrS patients with spontaneous type 1 ECG compared with those without, with a pooled adjusted hazard ratio (aHR) of 2.05 (95% CI 1.38–3.03) and an unadjusted hazard ratio of 2.97 (95% CI 2.04–4.34). Subgroup analysis revealed higher risks in studies with non-Asian populations and those including patients with no history of aborted cardiac arrest (aHR 2.36, 95% CI 1.35–4.11; and aHR 3.56, 95% CI 2.35–5.41, respectively) and a persistent significant risk in studies accounting for syncope as a covariate (aHR 2.01, 95% CI 1.24–3.27).

Conclusion

Our analysis indicates that patients with BrS and spontaneous type 1 ECG are at higher risk of MAEs. This is consistent across various subgroups, including asymptomatic individuals.

Abstract Image