{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T10:10:43Z","timestamp":1780567843963,"version":"3.54.1"},"reference-count":61,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,8,17]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Optimal management of asymptomatic Brugada syndrome (BrS) with spontaneous type I electrocardiographic pattern is uncertain.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">We developed an individual\u2010level simulation comprising 2\u00a0000\u00a0000 average\u2010risk individuals with asymptomatic BrS and spontaneous type I electrocardiographic pattern. We compared (1) observation, (2) electrophysiologic study (EPS)\u2010guided implantable cardioverter\u2010defibrillator (ICD), and (3) upfront ICD, each using either subcutaneous or transvenous ICD, resulting in 6 strategies tested. The primary outcome was quality\u2010adjusted life years (QALYs), with cardiac deaths (arrest or procedural\u2010related) as a secondary outcome. We varied BrS diagnosis age and underlying arrest rate. We assessed cost\u2010effectiveness at $100\u00a0000\/QALY. Compared with observation, EPS\u2010guided subcutaneous ICD resulted in 0.35 QALY gain\/individual and 4130 cardiac deaths avoided\/100\u00a0000 individuals, and EPS\u2010guided transvenous ICD resulted in 0.26 QALY gain and 3390 cardiac deaths avoided. Compared with observation, upfront ICD reduced cardiac deaths by a greater margin (subcutaneous ICD, 8950; transvenous ICD, 6050), but only subcutaneous ICD improved QALYs (subcutaneous ICD, 0.25 QALY gain; transvenous ICD, 0.01 QALY loss), and complications were higher. ICD\u2010based strategies were more effective at younger ages and higher arrest rates (eg, using subcutaneous devices, upfront ICD was the most effective strategy at ages 20\u201339.4 years and arrest rates &gt;1.37%\/year; EPS\u2010guided ICD was the most effective strategy at ages 39.5\u201351.3 years and arrest rates 0.47%\u20131.37%\/year, and observation was the most effective strategy at ages &gt;51.3 years and arrest rates &lt;0.47%\/year). EPS\u2010guided subcutaneous ICD was cost\u2010effective ($80\u00a0508\/QALY).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Device\u2010based approaches (with or without EPS risk stratification) can be more effective than observation among selected patients with asymptomatic BrS. BrS management should be tailored to patient characteristics.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.121.021144","type":"journal-article","created":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T09:37:02Z","timestamp":1628847422000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Comparative Effectiveness of Implantable Defibrillators for Asymptomatic Brugada Syndrome: A Decision\u2010Analytic Model"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2840-4539","authenticated-orcid":false,"given":"Shaan","family":"Khurshid","sequence":"first","affiliation":[{"name":"Cardiology Division Massachusetts General Hospital Boston MA"},{"name":"Cardiovascular Research Center Massachusetts General Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanyi","family":"Chen","sequence":"additional","affiliation":[{"name":"Institute for 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