Genotype-Phenotype Correlation of <i>SCN5A</i> Genotype in Patients With Brugada Syndrome and Arrhythmic Events: Insights From the SABRUS in 392 Probands

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<jats:sec> <jats:title>Background:</jats:title> <jats:p> Brugada syndrome (BrS) is associated with mutations in the cardiac sodium channel gene, <jats:italic>SCN5A.</jats:italic> However, genetic studies of patients with BrS with arrhythmic events have been limited. We sought to compare various clinical, ECG, and electrophysiological parameters according to <jats:italic>SCN5A</jats:italic> genotype in a large cohort of BrS probands with first arrhythmic event. </jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p> Survey on Arrhythmic Events in Brugada Syndrome is a survey of 10 Western and 4 Asian countries, gathering 678 patients with BrS with first arrhythmic event. Only probands were included, and <jats:italic>SCN5A</jats:italic> genotype adjudicated. Patients without appropriate genetic data were excluded. Associations of genotype with clinical features were analyzed. </jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p> The study group comprised 392 probands: 92 (23.5%) <jats:italic>SCN5A+</jats:italic> (44 pathogenic/likely pathogenic [P/LP] and 48 variants of unknown significance) and 300 (76.5%) <jats:italic>SCN5A−.</jats:italic> <jats:italic>SCN5A</jats:italic> missense variants and the patients hosting them were similar regardless of adjudication. A higher proportion of patients with P/LP were pediatric (<16 years) compared with <jats:italic>SCN5A−</jats:italic> (11.4% versus 3%, <jats:italic>P</jats:italic> =0.023). The proportion of females was higher among patients with P/LP compared with <jats:italic>SCN5A</jats:italic> − (18.2% versus 6.3%, <jats:italic>P</jats:italic> =0.013). P/LP probands were more likely to have a family history of sudden cardiac death compared with <jats:italic>SCN5A</jats:italic> − (41.9% versus 16.8%, <jats:italic>P</jats:italic> <0.001). A higher proportion of patients with P/LP were White compared with <jats:italic>SCN5A−</jats:italic> (87.5% versus 47%, <jats:italic>P</jats:italic> <0.001). Ethnicity (odds ratio, 5.41 [2.8–11.19], <jats:italic>P</jats:italic> <0.001) and family history of sudden cardiac death (odds ratio, 2.73 [1.28–5.82], <jats:italic>P</jats:italic> =0.009) were independent variables associated with P/LP genotype following logistic regression. </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p> The genetic basis of BrS has a complex relationship with gender, ethnicity, and age. Probands hosting a P/LP variant tended to experience their first arrhythmic event at a younger age and to have events triggered by fever compared with patients with <jats:italic>SCN5A−</jats:italic> . In addition, they were more likely to be White and to have family history of sudden cardiac death. Among females, a P/LP variant suggests an increased risk of being symptomatic. This association should be further studied on an ethnically specific basis in large prospectively collected international cohorts. </jats:p> </jats:sec>

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