Usefulness of aVR sign as a predictor of sudden cardiac death or appropriate ICD shocks in Brugada syndrome: A systematic review and meta-analysis of cohort studies.

Abstract

<h4>Introduction</h4>Several electrocardiograph markers are proposed as predictors of life-threatening arrhythmia in Brugada Syndrome, including the aVR sign. However, results of previous studies were inconsistent. Therefore, we aim to determine whether the aVR sign can predict sudden cardiac death in BrS patients.<h4>Methods</h4>We extracted data from PubMed, Cochrane, and EBSCO using MeSH keywords "Brugada syndrome, sudden cardiac death, arrhythmia". Inclusion criteria include cohorts from the last 10 years of the BrS population with the aVR sign as a predictor. We excluded patients with channelopathies other than Brugada syndrome and low-quality studies. We assessed the quality of studies using the Newcastle-Ottawa Scale. Data will be presented as odds ratios with 95 % confidence intervals. The endpoint is life-threatening arrhythmia resulting in sudden cardiac death.<h4>Results</h4>From 7 cohort studies (1763 patients), R-wave amplitude ≥3 mV in lead aVR has increased risk of sudden cardiac death (OR = 2.15, 95 % CI = 1.56-2.98, I² = 0 %). R/q ratio ≥0.75 in aVR is also associated with increased risk. All studies were considered good quality based on the Newcastle-Ottawa scale. These markers may be integrated with other factors to identify the high-risk patients.<h4>Conclusion</h4>aVR sign can predict sudden cardiac death in Brugada syndrome and this marker may be considered for risk assessment and lead the management strategy for better prevention.