Spontaneous type 1 ECG and arrhythmic risk in Brugada Syndrome: a meta-analysis of adjusted time-to-event data

Abstract Background Brugada Syndrome (BrS) is associated with an increased risk of major arrhythmic events (MAEs), particularly in patients with a spontaneous Type 1 ECG pattern. Objective Since previous meta-analyses used mainly crude or unadjusted data from observational studies, we conducted an updated meta-analysis on the prognostic role of spontaneous type 1 ECG in BrS patients combining adjusted and unadjusted data separately. Methods We conducted a systematic search of PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to May 2024. Studies providing hazard ratios (HRs) for MAEs associated with spontaneous type 1 ECG in BrS patients were included. Results 18 studies comprising 7238 patients were included, with 10 providing adjusted and 17 providing unadjusted data. Separate pooled analyses using a random-effects model demonstrated a significantly increased risk of MAEs in BrS patients with spontaneous type 1 ECG compared to those without, with a pooled adjusted HR (aHR) of 2.05 (95% CI: 1.38; 3.03) and unadjusted HR (uHR) of 2.97 (95% CI: 2.04; 4.34). Subgroup analysis revealed higher risks in studies with non-Asian populations and those including patients with no history of aborted cardiac arrest (ACA) (aHR = 2.36, 95% CI: 1.35; 4.11, and 3.56, 95% CI: 2.35; 5.41 respectively), and a persistent significant risk in studies accounting for syncope as a covariate (aHR = 2.01, 95% CI: 1.24; 3.27). Conclusion Our analysis indicates that patients with BrS and spontaneous type 1 ECG are at higher risk of MAEs. This is consistent across various subgroups, including asymptomatic individuals.Meta-analysis of adjusted HRs Meta-analysis of unadjusted HRs