Implantable cardioverter-defibrillator (ICD) the best treatment for secondary prevention in Brugada syndrome (BrS). However, asymptomatic patients are still being implanted, regardless the high rate of device complications. We compared the occurrence of complications in patients implanted an ICD in several French centers.

Method and results: Consecutive BrS Patients implanted an ICD for primary or secondary prevention were studied. Per- and post-implantation complications, and ICD programming controls were recorded. Patients or relatives were also contacted by telephone to check last news (alive or died). We studied 51 patients (mean age of 46.7±10.5 years, 10% of female). Spontaneous type 1 ECG pattern was found in 40 (78%) of patients and atrial fibrillation in 6 (12%). Prior to ICD implantation, No symptom, Syncope, and aborted cardiac arrest were found in 19 (37%), 24 (47%), and 8 (16%) patients respectively. During a median follow-up period of 76±41.7 months (at 1 to 192), appropriate ICD shocks occurred in 11 (21.5%) patients of whom 90% had spontaneous coved type ECG, 40% had previous syncope and 60% already have experienced aborted SCD. Seven (13.7%) patients had inappropriate shocks (IS), of whom 5 (71.4%) in asymptomatic, 28.6% in syncope group, and none in resuscitated group. Other Complications were reported in 10 (19.6%) patients. Lead fracture, Lead dislodgement, pneumothorax, pocket infection, myocardial perforation, and re-operation for any reason occurred in 4 (7.8%), 2 (3.9%), 1 (1.9%), 1 (1.9%), 1 (1.9%), and 9 (17.6%) respectively. The incidence of IS is higher in asymptomatic vs symptomatic patients if we consider the confidence interval of 90% (p=0.07) in this rare disease, whereas other complications had similar rate occurrence.

ICD was shown to be an effective therapy in symptomatic patients, particularly in those with previous cardiac arrest. However, the high rate of device complications, mainly inappropriate therapies recommends to accurately assess the risk-benefit of cardioverter-defibrillator and avoid this treatment in asymptomatic patients.