The utility of implantable loop recorder in the clinical management of pediatric patient with non-high-risk Brugada syndrome

Guix Camps, Judit
BACKGROUND: Brugada syndrome (BrS) is an inherited arrhythmogenic disorder characterized by a typical ECG pattern. The syndrome has incomplete penetrance and variable expressivity, ranging from asymptomatic to lethal ventricular arrhythmias and sudden death at a young age in individuals with structurally normal hearts. So, all this requires an early diagnosis and an accurate risk stratification of this population. HYPOTHESIS AND OBJECTIVE: We suggest the use of remote monitoring system using a subcutaneous loop recorder as a tool to detect arrhythmic events that can help in the risk stratification of pediatric patients with non-high-risk BrS. METHODS AND MATERIALS: A retrospective cohort study was performed to describe data collected by implantable loop recorder (ILR) of 34 anonymized pediatric patients with non-high-risk BrS. Their demographic and clinical characteristics and the results obtained in all diagnostic tests performed, were analyzed in comparison to the detection of arrhythmic events by ILR. RESULTS: Within 34 patients, 24 were male (70,59%) and 10 were female (29,41%). Among total arrhythmic events detected, 5 patients (45,45%) were previously symptomatic and 6 (54,55%) were previously asymptomatic. During a mean follow-up of 18 months, a total of 7 cases (63,64%), ILR was triggered by symptoms, which in the majority of them (71,43%) were proved normal sinus rhythm/sinus tachycardia or minimal rhythm disturbances. In the two remaining symptomatic cases (28,57%), the ECG tracing identified episodes of NSVT. That involved a change in those patients’ therapeutic management, requiring an early implantation of ICD. In four asymptomatic patients (36,36%) the ILR recording was auto-activated, showing in one of those cases (25%), various episodes of asymptomatic NSVT. In six cases (17,65%), ILR recorded episodes of abrupt change repolarization compatible with dynamic BrS. CONCLUSIONS: The ILR was determinant to exclude ventricular arrhythmias as a mechanism of symptoms in 71,43% of patients, delaying ICD implantation. In contrast, it allowed to detect ventricular arrhythmias in two symptomatic patients, leading to an early implantation of ICD. So, the ILR allows a long-term continue monitoring of heart rhythm in patients with increased risk of suffering life- threatening arrhythmias and should be considered as a tool for clinical management of paediatric patients with non-high-risk BrS ​
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