Inappropriate shocks in Brugada syndrome: a matter of data capture rather than programming?

This commentary refers to ‘Subcutaneous implantable cardiac defibrillator in Brugada syndrome: a prospective multicenter study’, by J.-B. Gourraud et al., https://doi.org/10.1093/eurheartj/ehaf743 and the discussion piece ‘Programming optimization is crucial for minimizing inappropriate shocks in patients with Brugada syndrome implanted with a subcutaneous implantable cardioverter-defibrillator’, by F. Migliore et al., https://doi.org/10.1093/eurheartj/ehag007. We are grateful to Dr. Migliore and colleagues for their insightful and constructive comments regarding our article ‘Subcutaneous implantable cardioverter-defibrillator in Brugada syndrome: a prospective multicentre study’. We appreciate their interest in our work and their commitment to improving the management of patients with Brugada syndrome undergoing S-ICD implantation. The authors raise the important issue of device programming and suggest that differences in programming strategies—particularly activation of discrimination algorithms and the SMART Pass filter—may account for the higher incidence of inappropriate shocks observed in our study compared with their Rhythm Detect registry.1,2 Obviously, we fully agree that optimal device programming is essential for minimizing inappropriate interventions, particularly in young patients. In our prospective multicentre study, device programming followed predefined settings reflecting contemporary recommendations, the average conditional zone was 213 b.p.m. with a median of 220 (200; 220), and the average fibrillation zone was 236 b.p.m. with a median of 240 (230; 240). We also recommended to systematically activate the SMART Pass filter in all patients whenever it was technically possible.