Are Women with Severely Symptomatic Brugada Syndrome Different from Men?

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.