Changes of sports habits and psychological impact of pharmacologically induced Brugada type 1 pattern in young patients
Authors: Dinatale A , Crocamo A , Notarangelo M F , Bearzot L , Gonzi G , Barocelli F , Russo F , Niccoli G , Ardissino D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Brugada syndrome (BrS) is an inherited disease characterized by an increased risk of sudden cardiac death (SCD). According to the latest ESC guidelines, provocation with sodium channel blocker test is less specific than previously thought, especially in asymptomatic patients(1). In these cases, in which the diagnosis of BrS itself can be controversial, management currently consists in clinical follow-up only. However, we still observe a big gap between the patient’s perception and medical recommendations of living a normal life.

Objective
The goal of this study was to analyze exercise habits before and after positive ajmaline testing (AT), focusing on its psychological impact on a population of low-risk young patients.

Methods
We enrolled all-comers patients with ajmaline-induced Brugada type 1 pattern who came to our department between 2015 and 2022. Patients were asked to rate their heart-focused anxiety using the German version of the Cardiac Anxiety Questionnaire (CAQ) (2) at last medical contact after ajmaline challenge. The intensity of habitual physical exercise was estimated in METs and divided in 3 categories: mild (&lt;3 METs), moderate (3-6 METs), intense (&gt;6 METs). Different groups were compared using Student’s t-test for continuous variables. Significance level was set to p&lt;0.05.

Results
A total of 87 patients resulted positive to ajmaline challenge; among these, 16 (18.4%) underwent EPS and 4 (4.6%) of them underwent ICD implantation. Therefore, our population included 83 patients. Mean age was 45.1±13.5 years; M/F ratio was 1.4/1. 12 patients (14.5%) had family history of SCD. Mean follow-up duration was 31.6±25.3 months. After positive AT, 5 patients (5.7%) did intense physical activity (PA), 27 (31.0%) did moderate PA, 51 (58.6%) were sedentary or practiced low-intensity PA. Mean CAQ score in the overall population was 19.1±6.6 points (fig. 1A), noticeably higher than the general population (2). As shown in fig. 1B, anxiety levels were significantly lower in patients who did almost moderate PA (p=0.03), independently from previous sport habits. This suggests sport to be a protective factor against anxiety. A total of 23 people (27.7%) reduced PA (fig. 2). We compared this population to the two groups of patients whose habits were not affected by the test: respectively high-high (n=22; 25.3%) and low-low groups (n=34; 39.1%). Anxiety in high-low group patients was not significantly different from the other two (fig. 1C), although it was higher than the general population.

Conclusions
After positive AT, many patients lead a sedentary lifestyle. Regardless of this, anxiety after the test is higher than the normal population. Anxiety levels do not change significantly between patients who reduced PA and those who did not change their habits. Further investigation is needed to assess the trade-offs between individual arrhythmic risk and global cardiovascular risk due to sedentary lifestyle in these patients.