Background:The new guideline (NG) published by the Japanese Circulation Society (JCS) places emphasis on previous arrhythmic syncope and inducibility of ventricular fibrillation (VF) by ≤2 extrastimuli during programmed electrical stimulation (PES) for deciding the indication of an implantable cardioverter-defibrillator in patients with Brugada syndrome (BrS). This study evaluated the usefulness of the NG and compared it with the former guideline (FG) for risk stratification of patients with BrS.

Methods and Results:This was a multicenter (7 Japanese hospitals) retrospective study involving 234 patients with BrS who underwent PES at baseline (226 males; mean age at diagnosis: 44.9±13.4 years). At diagnosis, 46 patients (20%) had previous VF, 100 patients (43%) had previous syncope, and 88 patients (37%) were asymptomatic. We evaluated the difference in the incidence of VF in each indication according to the new and FGs. During the follow-up period (mean: 6.9±5.2 years), the incidence of VF was higher in patients with Class IIa indication according to the NG (NG: 16/45 patients [35.6%] vs. FG: 16/104 patients [15.4%]), while the incidence of VF in patients with other than class I or IIa indication was similarly low in both guidelines (NG: 2/143 patients [1.4%] vs. FG: 2/84 patients [2.4%]).

Conclusions:This study validated the usefulness of the NG for risk stratification of BrS patients.

背景：日本循环学会 (JCS) 发布的新指南 (NG) 强调既往心律失常晕厥和心室颤动 (VF) 在程序性电刺激 (PES) 期间通过≤2 次额外刺激来确定植入式心脏复律器的适应症- Brugada 综合征 (BrS) 患者的除颤器。本研究评估了 NG 的有用性，并将其与之前的指南 (FG) 进行了比较，用于 BrS 患者的风险分层。

方法和结果：这是一项多中心（7 家日本医院）回顾性研究，涉及 234 名在基线时接受 PES 的 BrS 患者（226 名男性；诊断时的平均年龄：44.9±13.4 岁）。诊断时，46 名患者 (20%) 既往有 VF，100 名患者 (43%) 有晕厥史，88 名患者 (37%) 无症状。我们根据新指南和 FG 评估了每个适应症中 VF 发生率的差异。在随访期间（平均：6.9±5.2 年），根据 NG（NG：16/45 例 [35.6%] vs. FG：16/104 例），IIa 类适应症患者的 VF 发生率较高[15.4%])，而在两个指南中，I 类或 IIa 类适应症以外的患者的 VF 发生率同样低（NG：2/143 名患者 [1.4%] 与 FG：2/84 名患者 [2.4%] ）。

结论：本研究验证了 NG 对 BrS 患者风险分层的有用性。