Brugada syndrome: Eligibility for subcutaneous implantable cardioverter-defibrillator after exercise stress test

Brugada syndrome (BrS) is a channelopathy associated with ventricular arrhythmias and sudden cardiac death. In patients at high risk of sudden death, an implantable cardioverter-defibrillator is indicated. Subcutaneous implantable cardioverter-defibrillators (S-ICDs) are an alternative to transvenous systems, with reduced risk of infection and complications associated with system extraction or explantation. To test electrocardiographic eligibility for S-ICD placement after exercise stress testing (EST) in patients with BrS. The sample included 35 consecutive patients with BrS. Electrocardiographic eligibility was assessed using the Boston Scientific model 2889 EMBLEM™ S-ICD automated screening tool, in four phases: decubitus and orthostatism, and before and after EST. Those who had at least one acceptable vector in the four measurements were considered eligible. In this study, 71.4% of patients were male and mean age was 53.86±12 years. In screening prior to EST, 14.3% of patients (n=5) were not eligible for an S-ICD. There was a statistically significant association between ineligibility and presence of complete right bundle branch block and history of syncope. After EST, 16.7% of initially eligible patients no longer had eligible vectors (n=5). In this study, 16.7% of patients previously eligible for an S-ICD were no longer eligible after EST. This result demonstrates the importance of screening after EST in all patients with BrS and with indication for an S-ICD, and may influence decisions concerning which ICD to implant or whether to institute pharmacological measures that avoid inappropriate therapies. A síndrome de Brugada (SBr) é uma canalopatia associada ao desenvolvimento de arritmias ventriculares e morte súbita cardíaca. Pacientes com alto risco devem ser orientados para a colocação um cardioversor-desfibrilhador. O cardioversor-desfibrilhador implantável subcutâneo (CDI-S) é uma alternativa ao sistema transvenoso, com menor risco de infeção e complicações associadas à extração/explante do sistema. Testar a elegibilidade eletrocardiográfica para colocação de CDI-S após prova de esforço (PE) em pacientes com SBr. A amostra incluiu 35 pacientes, consecutivos, com SBr. A elegibilidade eletrocardiográfica foi avaliada pela ferramenta de rastreio automática, Boston-Emblem S-ICD (Modelo 2889)®, em quatro fases: decúbito e ortostatismo, antes e depois da PE – foram considerados elegíveis indivíduos que tinham pelo menos um vetor aceitável nas quatro fa