The present study sought to evaluate the incidence of cerebrovascular events in a large cohort of patients with Brugada syndrome (BrS) analysing possible predictors, clinical characteristics and prognosis of cardioembolic events secondary to atrial fibrillation.
A total of 671 consecutive patients (age 42.1 ± 17.0 years; men 63%) with a diagnosis of BrS were retrospectively analysed over a mean follow-up period of 10.8 ± 5.5 years. The diagnosis of ischemic stroke was made according to the AHA/ASA guidelines using computed tomography (CT) and angio-CT in the emergency department.
Among 671 patients with BrS, 79 (11.8%) had atrial fibrillation. The incidence of cardioembolic stroke in patients with BrS and atrial fibrillation was 13.9% (11 events). These patients had a low CHA2DS2Vasc score (82%, 0 and 1). Patients with transient ischemic attack/stroke were more frequently asymptomatic (91 vs. 25%; P < 0.0001) and older (59.4 ± 11.2 vs. 43.9 ± 16.7; P = 0.004) as compared with those without cerebrovascular events.
The incidence of cardioembolic stroke in patients with BrS and atrial fibrillation was unexpectedly high. The cerebrovascular accidents were often the presenting clinical manifestation and were significantly associated with asymptomatic atrial fibrillation and older age. CHADS2 and CHA2DS2Vasc scores did not predict the unexpectedly high risk of thromboembolic events in this group of patients. The use of more invasive diagnostic tools might be useful in order to increase the rate of atrial fibrillation detection.
aHeart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing
bCentre for Medical Genetics, European Reference Networks Guard-Heart
cCardiac Surgery Department, Universitair Ziekenhuis Brussel – Vrije Universiteit Brussel, Brussels, Belgium
Correspondence to Carlo de Asmundis, MD, PhD, Heart Rhythm Management Centre, Postgraduate program in Cardiac Electrophysiology and Pacing, Universiteit Ziekenhuis Brussel – Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium Tel: +32 2 476 3704; fax: +32 2 477 6851; e-mail: firstname.lastname@example.org;email@example.com
Received 15 March, 2018
Accepted 13 September, 2018