The Clinical Significance of Atrial Fibrillation in Non-High-Risk Brugada Syndrome: The BruFib Study.
Por:
Bergonti M, Sacher F, Belhassen B, Sarquella-Brugada G, Arbelo E, Sabbag A, Crotti L, Tfelt-Hansen J, Faccenda D, Casella M, Letsas KP, Rossi A, Schwartz PJ, Monaco C, Scheirlynck E, Pannone L, Russo V, Calò L, Caputo ML, Berne P, Vicentini A, Oezkartal T, Migliore F, Conti S, Compagnucci P, Scrocco C, Brugada P, de Asmundis C, Tondo C, Brugada-Terradellas J, Probst V, Behr ER and Conte G
Publicada:
1 nov 2025
Ahead of Print:
27 ago 2025
Resumen:
BACKGROUND: Atrial fibrillation (AF) occurs in up to 20% of patients with Brugada syndrome (BrS), yet its risk factors and prognostic implications remain uncertain. OBJECTIVES: This study sought to identify risk factors for AF in patients with non-high-risk BrS and to evaluate the impact of AF on ventricular arrhythmias (VAs), sick sinus syndrome (SSS), and stroke in non-high-risk BrS. METHODS: This was a multicenter, retrospective study conducted across 20 international centers. Non-high-risk BrS patients were stratified based on the presence or absence of AF. The primary endpoint was the occurrence of VAs, defined as sustained ventricular tachycardia, ventricular fibrillation, or arrhythmic sudden cardiac death. RESULTS: A total of 686 BrS patients were analyzed (39.3 years of age, 33.1% female, 31.8% spontaneous type 1 electrocardiogram, 36.0% pathogenic/likely pathogenic SCN5A variant), including 280 with AF (40.8%). Proband status and older age were associated with AF at Cox regression analysis. Over a median follow-up of 48.8 months, the incidence of VAs was 0.26% per year, with no significant difference between patients with and without AF (HR: 0.67; P = 0.58). Early-onset AF (<20 years) was associated with significantly higher risk of VAs (P < 0.001). SSS was twice as prevalent in BrS patients with AF (10.0% vs 6.2%; P = 0.047), and stroke occurred exclusively in the AF group (2.5%), despite low CHA(2)DS(2)-VA (mean 0.5). CONCLUSIONS: The presence of AF in non-high-risk BrS does not identify patients with higher risk of VAs. However, early-onset AF (<20 years) defines a distinct subgroup with elevated risk. Patients with AF and BrS have a significantly higher risk of SSS and stroke.
Filiaciones:
Bergonti M:
Cardiology Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
Sacher F:
Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque, Université Bordeaux, Bordeaux, France
Belhassen B:
Heart Institute, Hadassah Medical Center, Jerusalem and Tel Aviv University, Tel Aviv, Israel
Sarquella-Brugada G:
Hospital Sant Joan de Deu, Department of Cardiology, Barcelona, Spain
Arbelo E:
Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona. Barcelona, Spain
Institut d'Investigació August Pi i Sunyer, Barcelona, Spain
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
Sabbag A:
The Davidai Center for Rhythm Disturbances and Pacing, Chaim Sheba Medical Center, Tel Hashomer, Israel
Faculty of Medicine and Health Science, Tel Aviv University, Tel Aviv, Israel
Crotti L:
Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy
Tfelt-Hansen J:
Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
Section of Genetics, Department of Forensic Medicine, Faculty of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
Faccenda D:
Cardiology Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
Department of Cardiology, University of Naples Federico II, Naples, Italy
Casella M:
Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti," Ancona, Italy
Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
Letsas KP:
Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Onassis Cardiac Surgery Center, Athens, Greece
Rossi A:
Arrhythmology Division, Fondazione Toscana Gabriele Monasterio Consiglio Nazionale delle Richerche-Regione Toscana, Pisa, Italy
Schwartz PJ:
Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
Monaco C:
Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque, Université Bordeaux, Bordeaux, France
Scheirlynck E:
Cardiology Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
Pannone L:
Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Russo V:
Cardiology Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Monaldi Hospital, Naples, Italy
Calò L:
Department of Cardiology, Policlinico Casilino, Azienda Sanitaria Locale, Rome B, Rome, Italy
Caputo ML:
Cardiology Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
Berne P:
Department of Cardiology, Ospedale Santissima Annunziata, University of Sassari, Sassari, Italy
Vicentini A:
Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Oezkartal T:
Cardiology Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
Migliore F:
Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
Conti S:
Department of Cardiology, Electrophysiology Department, Azienda di Rilievo Nazionale ed Alta Specializzazione Ospedali Civico Di Cristina Benfratelli, Palermo, Italy
Compagnucci P:
Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti," Ancona, Italy
Scrocco C:
Cardiovascular and Genomics Research Institute, St George's, University of London and St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
Brugada P:
Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
de Asmundis C:
Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Tondo C:
Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
Department of Biomedical, Surgery and Dentist Sciences, University of Milan, Milan, Italy
Brugada-Terradellas J:
Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona. Barcelona, Spain
Probst V:
L'Institut du Thorax, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Nantes Université, Centre Hospitalier Universitaire Nantes, Nantes, France
Behr ER:
Cardiovascular and Genomics Research Institute, St George's, University of London and St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
Conte G:
Cardiology Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
Green Submitted, hybrid
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