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Lights and shadows of subcutaneous implantable cardioverter-defibrillator in Brugada syndrome

  • Gregory Dendramis
    Correspondence
    Address reprint requests and correspondence: Dr Gregory Dendramis, Cardiovascular Department, Clinical and Interventional Arrhythmology, ARNAS Ospedale Civico Di Cristina Benfratelli, Piazza Nicola Leotta 4 – 90127, Palermo, Italy.
    Affiliations
    Heart Rhythm Management Centre, UZ Brussel – VUB, Brussels, Belgium

    Cardiovascular Department, Clinical and Interventional Arrhythmology, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo, Italy
    Search for articles by this author
  • Pedro Brugada
    Affiliations
    Heart Rhythm Management Centre, UZ Brussel – VUB, Brussels, Belgium
    Search for articles by this author
Published:September 23, 2022DOI:https://doi.org/10.1016/j.hrthm.2022.09.016
      Currently the cornerstone of therapy for ventricular arrhythmic complications and sudden cardiac death prevention in Brugada syndrome (BrS) is an implantable cardioverter-defibrillator (ICD). BrS patient population differs from the majority of patients with an ICD implanted for structural heart disease, and as widely known, transvenous ICD (TV-ICD) systems have been associated with high complication rates in patients with BrS. Technological evolution of these devices has certainly reduced complications due to the device itself, but a careful preimplant screening of these patients is still essential. To date, criteria for an adequate screening process to select suitable candidates for a subcutaneous implantable cardioverter-defibrillator (S-ICD) from patients with BrS are sometimes nonstandardized and often lack important precautions that are instead fundamental to select the most suitable type of ICD for these patients. To better select suitable candidates for an S-ICD from patients with BrS, a full screening process should include screening during or immediately after an exercise test and after a drug provocation challenge test. We report an analysis of the “lights and shadows” of S-ICD for a correct use of this device in patients with BrS.

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