br Material and methods br Results
Material and methods
Discussion This study showed the rate of recurrent of VT/VF in symptomatic Thai BS patients who received ICD order Metformin as a secondary prevention. After approximately 1.5 years of follow-up, the recurrence of VT/VF in symptomatic BS patients in our series was 32%. All events were successfully treated by ICDs. The event rate in Thai patients was comparable with from the rate in other countries. After 3 years of follow-up of symptomatic Japanese BS patients, the rate of recurrent cardiac events after ICD implantation or secondary prevention was 25.7% . Similarly, the VT/VF rate in European BS patients treated with ICD was somewhat higher, at 34% . A report from France showed that most BS patients received ICD shock at random times, whereas in the present study, most patients (60%) experienced cardiac events during the night, similar to the findings of a previous report [3,9]. Thus, symptomatic BS patients in our region had cardiac events more frequently while they were sleeping. Although ICD therapy is the only proven effective treatment for symptomatic BS, some complications may occur after ICD implantation. In our study, inappropriate ICD shock occurred substantially less frequently compared to appropriate shock (9.7% vs. 32.3%). The inappropriate shock rate was lower than that of a previous report (20%) . Depression or fear of shock therapy may occur in BS patients who receive inappropriate shocks . In our study, the appropriate ICD shock rate was higher than that in the report by Sacher et al. (32.3% vs. 8%) . This finding may be explained by differences in the study populations. In the present study, 50 of 62 patients (80.64%) were symptomatic and had SCA. However, SCA patients accounted for only 8% of all patients in the previous study . To avoid inappropriate shock, adjustment of the ICD to only 1 VF zone with a detection rate above 180−200bpm in young, active patients is recommended . Another serious complication of infected ICD occurred in only 1 patient (1.6%). Because of the high rate of recurrent VT/VF and low rate of ICD complications, ICD treatment is recommended for all symptomatic BS patients [8–10]. Several clinical parameters have been demonstrated to predict a worse outcome in BS patients, including severe symptoms at diagnosis (SCA), spontaneous type 1 Brugada ECG at diagnosis, male sex, and family history of SCA . The results of this study confirmed that symptomatic BS patients in our setting, particularly those presenting with SCA, should receive ICD therapy because of a high probability of recurrent VT/VF events. Subsequent device programming and regular follow-up are required to minimize the occurrence of inappropriate shock.
Conflicts of interests
Introduction The prevalence of atrial fibrillation (AF) increases with age, and Japan has one of the fastest aging populations in the world. Warfarin is highly effective in reducing the risk of stroke in patients with AF. However, warfarin is subject to several shortcomings, such as its narrow therapeutic window, need for frequent coagulation monitoring, slow onset and offset of action, and numerous drug and food interactions [1,2]. Moreover, there are no net clinical benefits of warfarin for patients with non-valvular AF (NVAF) and lower CHADS2 (congestive heart failure, hypertension, age>75 years, diabetes, stroke/transient ischemic attack) scores of 0–1 . Therefore, physicians have often been hesitant to prescribe anticoagulation therapy for NVAF patients with lower CHADS2 scores. Dabigatran is a novel oral anticoagulant that is a potent, direct, competitive, and reversible inhibitor of thrombin. The RE-LY, a randomized evaluation trial of long-term anticoagulation therapy and its sub-analysis, demonstrated that dabigatran (220 or 300mg/day) has many clinical advantages for anticoagulation in patients with NVAF as compared with warfarin [4–7]. Therefore, dabigatran has been approved in many countries for the prevention of strokes in patients with NVAF [8,9]. However, there is little clinical evidence for its use in Japanese AF patients [10–12]. Furthermore, severe bleeding complications after dabigatran administration have been reported in some Japanese patients . Thus, the aim of this study was to clarify the efficacy and safety of anticoagulation with dabigatran in Japanese patients with NVAF.