TY - JOUR
T1 - Syncope in Brugada syndrome
T2 - prevalence, clinical significance, and clues from history taking to distinguish arrhythmic from nonarrhythmic causes
AU - Olde Nordkamp, Louise R. A.
AU - Vink, Arja S.
AU - Wilde, Arthur A. M.
AU - de Lange, Freek J.
AU - de Jong, Jonas S. S. G.
AU - Wieling, Wouter
AU - van Dijk, Nynke
AU - Tan, Hanno L.
N1 - Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
PY - 2015/2
Y1 - 2015/2
N2 - BACKGROUND: Syncope in Brugada syndrome (BrS) patients is a sign of increased risk for sudden cardiac death and usually is ascribed to cardiac arrhythmias. However, syncope often occurs in the general population, mostly from nonarrhythmic causes (eg, reflex syncope).OBJECTIVE: The purpose of this study was to distinguish arrhythmic events from nonarrhythmic syncope in BrS and to establish the clinical relevance of nonarrhythmic syncope.METHODS: We reviewed the patient records of 342 consecutively included BrS patients and conducted systematic interviews in 141 patients with aborted cardiac arrest (ACA) or syncope.RESULTS: In total, 23 patients (7%) experienced ECG-documented ACA and 118 (34%) syncope; of these 118, 67 (57%) were diagnosed with suspected nonarrhythmic syncope. Compared to suspected nonarrhythmic syncope patients, ACA patients were older at first event (45 vs 20 years), were more likely to be male (relative risk 2.1) and to have urinary incontinence (relative risk 4.6), and were less likely to report prodromes. ACA was never triggered by hot/crowded surroundings, pain or other emotional stress, seeing blood, or prolonged standing. During follow-up (median 54 months), ACA rate was 8.7% per year among ACA patients and 0% per year among suspected nonarrhythmic syncope patients.CONCLUSION: Syncope, especially nonarrhythmic syncope, often occurs in BrS. The high incidence of nonarrhythmic syncope must be taken into account during risk stratification. Arrhythmic events and nonarrhythmic syncope may be distinguished by clinical characteristics (absence of prodromes and, particularly, specific triggers), demonstrating the importance of systematic history taking.
AB - BACKGROUND: Syncope in Brugada syndrome (BrS) patients is a sign of increased risk for sudden cardiac death and usually is ascribed to cardiac arrhythmias. However, syncope often occurs in the general population, mostly from nonarrhythmic causes (eg, reflex syncope).OBJECTIVE: The purpose of this study was to distinguish arrhythmic events from nonarrhythmic syncope in BrS and to establish the clinical relevance of nonarrhythmic syncope.METHODS: We reviewed the patient records of 342 consecutively included BrS patients and conducted systematic interviews in 141 patients with aborted cardiac arrest (ACA) or syncope.RESULTS: In total, 23 patients (7%) experienced ECG-documented ACA and 118 (34%) syncope; of these 118, 67 (57%) were diagnosed with suspected nonarrhythmic syncope. Compared to suspected nonarrhythmic syncope patients, ACA patients were older at first event (45 vs 20 years), were more likely to be male (relative risk 2.1) and to have urinary incontinence (relative risk 4.6), and were less likely to report prodromes. ACA was never triggered by hot/crowded surroundings, pain or other emotional stress, seeing blood, or prolonged standing. During follow-up (median 54 months), ACA rate was 8.7% per year among ACA patients and 0% per year among suspected nonarrhythmic syncope patients.CONCLUSION: Syncope, especially nonarrhythmic syncope, often occurs in BrS. The high incidence of nonarrhythmic syncope must be taken into account during risk stratification. Arrhythmic events and nonarrhythmic syncope may be distinguished by clinical characteristics (absence of prodromes and, particularly, specific triggers), demonstrating the importance of systematic history taking.
KW - Adult
KW - Brugada Syndrome/complications
KW - Electrocardiography
KW - Female
KW - Follow-Up Studies
KW - Heart Rate/physiology
KW - Humans
KW - Male
KW - Medical History Taking/methods
KW - Middle Aged
KW - Physical Examination
KW - Prevalence
KW - Prognosis
KW - Retrospective Studies
KW - Syncope/epidemiology
KW - Time Factors
U2 - https://doi.org/10.1016/j.hrthm.2014.10.014
DO - https://doi.org/10.1016/j.hrthm.2014.10.014
M3 - Article
C2 - 25311410
SN - 1547-5271
VL - 12
SP - 367
EP - 375
JO - Heart Rhythm
JF - Heart Rhythm
IS - 2
ER -