Clinical characteristics and risk of arrhythmic events in patients younger than 12 years diagnosed with Brugada syndrome

Daniela Righi; Luigina Porco; Camilla Calvieri; Pietro Paolo Tamborrino; Corrado Di Mambro; Simone Paglia; Anwar Baban; Massimo Stefano Silvetti; Maria Gnazzo; Antonio Novelli; Alberto Eugenio Tozzi; Fabrizio Drago

doi:10.1016/j.hrthm.2021.06.1177

Clinical characteristics and risk of arrhythmic events in patients younger than 12 years diagnosed with Brugada syndrome

Heart Rhythm. 2021 Oct;18(10):1691-1697. doi: 10.1016/j.hrthm.2021.06.1177. Epub 2021 Jun 17.

Affiliations

¹ Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart).
² Medical Genetics Unit, Medical Genetics Laboratory, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
³ Multifactorial and Complex Diseases Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
⁴ Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart). Electronic address: [email protected].

PMID: 34147702
DOI: 10.1016/j.hrthm.2021.06.1177

Abstract

Background: Brugada syndrome (BrS) is an inheritable disease with an increased risk of sudden cardiac death. Although several score systems have been proposed, the management of children with BrS has been inconsistently described.

Objective: The purpose of this study was to identify the characteristics, outcome, and risk factors associated with cardiovascular and arrhythmic events (AEs) in children younger than 12 years with BrS.

Methods: In this single-center case series, all children with spontaneous or drug/fever-induced type 1 Brugada electrocardiographic (ECG) pattern and younger than 12 years at the time of diagnosis were enrolled.

Results: Forty-three patients younger than 12 years at the time of diagnosis were included. The median follow-up was 3.97 years (interquartile range 2-12 years). In terms of first-degree atrioventricular block, premature beats, nonmalignant AEs, malignant AEs, and episodes of syncope, no significant differences were observed either between patients with spontaneous and drug/fever-induced type 1 Brugada ECG pattern or between female and male patients (except a significant difference between female and male patients for first-degree atrioventricular block). A higher incidence of malignant AEs was observed in patients with syncope (3 of 8 [37.5%] vs 0 of 35 [0%]; P = .005) than in patients without syncope. SCN5A mutations were associated with a higher occurrence of malignant AEs (3 of 14 [21.4%] vs 0 of 25 [0%]; P = .04) compared with no SCN5A mutations.

Conclusion: A spontaneous type 1 Brugada ECG pattern is not associated with a higher incidence of syncope, first-degree atrioventricular block, premature beats, nonmalignant AEs, and malignant AEs than the drug/fever-induced type 1 Brugada ECG pattern. Syncope events are correlated with an increased incidence of malignant AEs. Moreover, SCN5A mutations are associated with a higher occurrence of malignant AEs.

Keywords: Arrhythmic event; Brugada syndrome; Children; Syncope; Type 1 Brugada ECG pattern.

Publication types

Observational Study

MeSH terms

Atrioventricular Block / epidemiology
Atrioventricular Block / etiology*
Brugada Syndrome / complications
Brugada Syndrome / diagnosis*
Brugada Syndrome / physiopathology
Child
Child, Preschool
Death, Sudden, Cardiac / epidemiology
Death, Sudden, Cardiac / etiology
Echocardiography, Doppler / methods*
Electrocardiography, Ambulatory / methods*
Female
Follow-Up Studies
Humans
Incidence
Italy / epidemiology
Male
Risk Assessment / methods*
Risk Factors
Survival Rate / trends
Syncope / epidemiology
Syncope / etiology*
Time Factors