Are Women with Severely Symptomatic Brugada Syndrome Different from Men?

Authors


  • Dr. Lacroix has received honoraria from Biosense-Webster, Europe, for work as a consultant on studies relevant to this topic.

  • Manuscript received 5 January 2008; Revised manuscript received 24 March 2008; Accepted for publication 4 April 2008.

Address for correspondence: Frédéric Sacher, M.D., Hôpital Cardiologique du Haut-Lévêque, 33604 Bordeaux-Pessac, France. Fax: 33-5-57656509; E-mail: frederic.sacher@chu-bordeaux.fr

Abstract

Introduction: Spontaneous type-1 ECG has been recognized as a risk factor for sudden cardiac death (SCD) in Brugada syndrome (BrS), but studied populations predominantly consisted of men. We sought to investigate whether a spontaneous type-1 ECG pattern was also associated in women with severely symptomatic BrS. Other known risk factors were also examined for gender specificity.

Methods: Patients with severely symptomatic BrS, defined as resuscitated SCD and/or appropriate implantable cardioverter-defibrillator (ICD) shock, were included from 11 European centers. Clinical data, investigation of family history, 12-lead ECG, and results of electrophysiological study (EPS) were collected. The average follow-up was 4 ± 3 years.

Results: Fifty-eight patients fulfilled the inclusion criteria (mean age 47 ± 11 years, 8 women). Thirty-six men (72%) but only two women (25%) had a spontaneous type-1 ECG at baseline (P = 0.02). Maximal ST elevation before or after drug challenge was 3.7 ± 1.3 mm in men versus 2.4 ± 0.7 mm in women (P = 0.007). The proportion of patients with a family history of SCD or an SCN5A mutation was not significantly different between both groups. Of those patients with high-risk BrS who underwent EPS, 76%(12/25) of men and 50%(2/4) of women had a positive study.

Conclusion: In contrast to men, most women with BrS and resuscitated SCD or appropriate ICD shock do not have a spontaneous type-1 ECG pattern. In addition, the degree of ST elevation is less pronounced in women than men. While women represent a lower-risk group overall, risk factors established from a predominantly male population may not be helpful in identifying high-risk females.

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