# Risk stratification of elderly patients with Brugada syndrome: Results from a large Japanese cohort of idiopathic ventricular fibrillation

## TL;DR

Elderly patients with Brugada syndrome have a lower risk of dangerous heart rhythms compared to younger patients, especially if they are asymptomatic.

## Contribution

This study provides risk stratification insights for elderly Brugada syndrome patients using a large Japanese cohort.

## Key findings

- Elderly patients had a lower annual incidence of cardiac events compared to nonelderly patients.
- A history of ventricular fibrillation was a strong predictor of future cardiac events in elderly patients.
- Programmed electrical stimulation did not predict cardiac events in elderly patients.

## Abstract

Brugada syndrome (BrS) is an inherited cardiac channelopathy associated with a high risk of sudden cardiac death (SCD) due to ventricular fibrillation (VF). Although implantable cardioverter‐defibrillators (ICDs) are the primary therapy for SCD prevention, the risk stratification of elderly patients with BrS remains unclear. This study aimed to evaluate the incidence and risk factors of life‐threatening arrhythmias in elderly patients with BrS.

We analyzed 523 patients with BrS (mean age 51 ± 13 years, 497 men) enrolled in the multicenter prospective Japan Idiopathic Ventricular Fibrillation Study. Patients were categorized into the elderly (>60 years, n = 150) and nonelderly (≤60 years, n = 373) groups. Clinical characteristics, programmed electrical stimulation (PES) results, and outcomes, including cardiac events (CEs: VF, fast ventricular tachycardia, or SCD), were compared. Statistical analyses were performed using Kaplan–Meier curves and Cox proportional hazard models.

During a mean follow‐up of 106 ± 62 months, 59 patients (11%) experienced CE. The annual CE incidence was lower in the elderly group than in the nonelderly group (0.7% vs. 1.5%, p = 0.016). History of VF independently predicted CE occurrence in elderly patients (hazard ratio: 23.5, p < 0.001). Asymptomatic elderly patients exhibited a negligible risk of CE. PES did not predict CE occurrence in the elderly group.

Elderly patients with BrS have a better prognosis than nonelderly patients, particularly if they are asymptomatic. A history of VF is a key risk factor for life‐threatening arrhythmias in elderly patients with BrS.

This study suggests that asymptomatic elderly patients with Brugada syndrome may be at a very low risk of developing life‐threatening arrhythmias.