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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Gender Differences in Clinical Manifestations of Brugada Syndrome

Begoña Benito, MD^_*, Andrea Sarkozy, MD, Lluis Mont, MD, PhD^_*, Stephan Henkens, RN, Antonio Berruezo, MD^_*, David Tamborero, BEng^_*, Dabit Arzamendi, MD^_*, Paola Berne, MD^_*, Ramon Brugada, MD, PhD, Pedro Brugada, MD, PhD and Josep Brugada, MD, PhD^_*,_*

^_* Cardiology Department, The Thorax Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
Heart Rhythm Management Centre, Cardiovascular Institute, UZ Brussel, VUB Brussels, Belgium
Cardiovascular Genetics Center, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada

Manuscript received June 23, 2008; accepted July 30, 2008.

^_* Reprint requests and correspondence: Dr. Josep Brugada, The Thorax Institute, Hospital Clínic, University of Barcelona, c/Villarroel 170, 08036, Barcelona, Spain (Email: jbrugada{at}clinic.ub.es).

Objectives: We sought to assess differences in phenotype and prognosis between men and women in a large population of patients with Brugada syndrome.

Background: A male predominance has been reported in the Brugada syndrome. No specific data are available, however, concerning gender differences in the clinical manifestations and their role in prognosis.

Methods: Patients with Brugada syndrome were prospectively included in the study. Data on baseline characteristics, electrocardiogram parameters before and after pharmacological test, and events in follow-up were recorded for all patients.

Results: Among 384 patients, 272 (70.8%) were men and 112 (29.2%) women. At inclusion, men had experienced syncope more frequently (18%) or aborted sudden cardiac death (6%) than women (14% and 1%, respectively, p = 0.04). Men also had greater rates of spontaneous type-1 electrocardiogram, greater ST-segment elevation, and greater inducibility of ventricular fibrillation (p < 0.001 for all). Conversely, conduction parameters and corrected QT intervals significantly increased more in women in response to sodium blockers (p = 0.03 and p = 0.001, respectively). During a mean follow-up of 58 ± 48 months, sudden cardiac death or documented ventricular fibrillation occurred in 31 men (11.6%) and 3 women (2.8%; p = 0.003). The presence of previous symptoms was the most important predictor for cardiac events in men, whereas a longer PR interval was identified among those women with a greater risk in this series.

Conclusions: Men with Brugada syndrome present with a greater risk clinical profile than women and have a worse prognosis. Although classical risk factors identify male patients with worse outcome, conduction disturbances could be a marker of risk in the female population.

Key Words: Brugada syndrome • gender • sudden cardiac death

Abbreviations and Acronyms   CI = confidence interval   ECG = electrocardiogram   EPS = electrophysiological study   GPD1-L = glycerol-3 phosphate dehydrogenase-1 like   HR = hazard ratio   ICD = implantable cardioverter-defibrillator   Ito = potassium current   QTc = corrected QT interval   SCD = sudden cardiac death   SUDS = sudden unexplained death syndrome   VF = ventricular fibrillation

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