Gender related clinical effects and management in patients with Brugada Syndrome

Brugada Syndrome (BS) is a genetic condition leading to increased risk of sudden cardiac death (SCD). Although both sexes inherit the genetic mutation equally and BS manifests more severely in men, recent research denotes that high-risk women with BS might not be underestimated.

To evaluate gender-based differences in clinical presentation and outcomes in BS patients.

A multicentre prospective observational study was conducted with patients ≥18 to ≤55 years who were diagnosed, managed and followed up with BS according to latest guidelines in our centres in the last 2 years. Patients with structural heart disease, diseases that may affect gonadal hormone levels, or patients who had previously undergone epicardial ablation for BS were excluded. Patients regularly followed-up, including Implantable-cardiac-defibrillator (ICD) checks in implanted subjects at 3-months-intervals. Gender-specific statistics and logistic regression models were used to identify clinical sex-differences and predictors of ICD implantation and syncope.

82 BS patients [male n: 52 (63,4%)] were enrolled with a mean age of 36.5±15 years and a mean follow-up of 12±5,3 months. Baseline ECG and clinical parameters were presented in tables 1-3. The majority of patients were males and probands. Males exhibited more spontaneous Type-1-ECG patterns, a history of atrial fibrillation (AF), longer PR and HV-intervals, and were more likely to receive ICD shocks. In contrast, females showed a greater incidence of sinus node dysfunction, more SVT diagnoses, AVNRT ablations, and longer QRS and QTc durations. ICD implantations were similar between genders, but female patients demonstrated significantly more high-atrial-rate-episodes checks. Younger patients showed prominent ST segment/j-point elevations on the Ajmalin-Drug-Challenge-Test, with extended PR intervals compared to older individuals.

When a Logistic Regression Analysis model for predicting "Implantation of ICD and Syncope" was conducted for each gender (Table 4-8), it was significantly shown that AF and syncope were significant predictors of ICD implantation in women, while not in men. Age, SCN5A mutation status, and family history of SCD did not significantly predict ICD implantation in either gender. In predicting syncope, ICD implantation was found to be protective in women but not significant in men. AF was a significant predictor of syncope in both genders, whereas family history of SCD predicted syncopal events in men only.

Gender plays a critical role in the clinical management of BS, with men showing a more severe arrhythmogenic profile and women presenting with SVTs and AF as significant predictors of poor outcomes. These findings emphasize the importance of tailored management strategies in BS and the need for further exploration of hormonal influences on arrhythmic risk.Table 1-3  Table 4-5