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Abnormally high risk of stroke in Brugada syndrome

de Asmundis, Carloa; Mugnai, Giacomoa; Chierchia, Gian-Battistaa; Sieira, Juana; Ströker, Erwina; Conte, Giulioa; Rodriguez-Mañero, Moisesa; Pappaert, Gudruna; Van Dooren, Soniab; De Regibus, Valentinaa; La Meir, Markc; Brugada, Pedroa

Journal of Cardiovascular Medicine: February 2019 - Volume 20 - Issue 2 - p 59–65
doi: 10.2459/JCM.0000000000000723
Research articles: Arrhythmias

Background 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.

Methods 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.

Results 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.

Conclusion 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:;

Received 15 March, 2018

Accepted 13 September, 2018

© 2019 Italian Federation of Cardiology. All rights reserved.