What is the efficacy of electrophysiologic study (EPS) for the diagnosis of Brugada syndrome (BrS)?

Updated: Apr 03, 2020
  • Author: Jose M Dizon, MD; Chief Editor: Mikhael F El-Chami, MD  more...
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Answer

More recently, investigators independently examining a large series of patients from Europe and Japan have failed to find any predictive value for EPS. In the large registry of Brugada syndrome patients from Europe, only symptoms and a spontaneous type 1 Brugada ECG pattern, but not EPS, were predictive of arrhythmic events. [39] In the smaller Japanese registry, only family history of sudden cardiac death at younger than 45 years and inferolateral early repolarization pattern on ECG predicted cardiac events. [34]

A study by Priori et al enrolled 308 patients with no history of cardiac arrest and a spontaneous or drug-induced type I ECG pattern. [40] Seventy eight of the patients had an ICD implanted prophylactically. EPS with a consistent stimulation protocol was performed on all patients; at a mean follow-up of 34 months, no differences were found in the incidence of appropriate ICD shocks or cardiac arrest between patients who were inducible and patients who were noninducible. Significant predictors of arrhythmia in this study included syncope and a spontaneous type I ECG pattern, a ventricular effective refractory period of less than 200 ms on EPS, and a fragmented QRS in the anterior precordial ECG leads.

Investigators from the United Kingdom examined a group of probands who suffered sudden arrhythmic death believed to be due to Brugada syndrome. [41] A retrospective review of risk factors determined that these patients would not have been considered high risk, calling into question the sensitivity of current risk factors (eg, symptoms, type I ECG pattern). However, few ECGs were available for examination in the probands with sudden death .


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