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Prof. Christian Wolpert,
Prof. Brugada presented the data on his large registry population in which the risk of experiencing sudden death or an appropriate ICD intervention was 5 fold in patients with inducible ventricular fibrillation compared to non-inducible patients. Besides, he also showed for his population that those patients who died during follow-up were not studied invasively in a number of cases, and that if they had been studied by programmed ventricular stimulation, mortality could have been reduced.
In his conclusion and rebuttal in the debate he stated that electrophysiological study should be performed not only to predict a too high risk, but also to decide against an ICD in primary prevention, because the negative predictive value of non-inducibility is also high.
His opponent Prof. Probst presented data from another large registry, in which the overall mortality as well as the mortality in asymptomatic patients with an abnormal baseline ECG was very low over a mid-term follow-up, and the positive predictive value of programmed stimulation is low. He also presented data on inappropriate ICD interventions and complications in ICD therapy in patients with a Brugada syndrome, which he balanced against the risk reduction.
Prof. Napolitano presented data in which phenotype manifestations correlated with specific mutations, and discussed whether a mutation could be identified at all. Furthermore, he said that the number of mutations and the channels affected that are being discovered is increasing steadily.
Prof. Wilde said that for scientific purposes, genetic screening is of great advantage and that also the search for modifier genes is warranted to better understand the various phenotypes. He agreed with Prof. Napolitano that it is too early to decide on therapy based on the genotype.
This was a very interesting debate session with a very balanced overview on the divergent data, and a lively discussion touching not only on leading edge science but also concrete clinical decision making.
Risk stratification in Brugada syndrome
This congress report accompanies a presentation given at the ESC Congress 2008. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.
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