Gender difference in clinical and genetic characteristics of Brugada syndrome

Background: Brugada syndrome (BrS) is a heritable sudden cardiac death (SCD) disease with male predominance. Information on gender difference of BrS remains scarce. Aim: To investigate the gender difference of BrS in Han Chinese. Design: We consecutively enrolled 169 BrS patients (153 males and 16 females) from Han Chinese in Taiwan from 1998 to 2017. Methods: Clinical characteristics, electrocardiographic parameters and SCN5A mutation status were compared between genders. Results: The percentage of family history of SCD in females was slightly higher (31.3% vs. 15%, P ¼ 0.15). Females exhibited longer QTc (457.8 6 33.0 vs. 429.5 6 42.1 ms, P < 0.01). Regarding cumulative event occurrence by age, Mantel-Cox test showed females had earlier age of onset of first cardiac events (SCD or syncope) than males (P ¼ 0.049), which was mainly attributed to syncope (P < 0.01). Males with SCD exhibited longer QRS duration (114.2 6 26.8 vs. 104.8 6 15.3 ms, P ¼ 0.02) and QTc (442.5 6 57.4 vs. 422.9 6 28.8 ms, P ¼ 0.02). Males with syncope exhibited longer PR interval (181.2 6 33.7 vs. 165.7 6 27.1 ms, P ¼ 0.01), whereas females with SCD or syncope had a trend towards slower heart rates (69.1 6 9.6 vs. 82.2 6 16.3 bpm, P ¼ 0.10) than female with no or mild symptoms. There was no difference in the percentage of SCN5A mutation between genders. Conclusion: Gender difference is present in BrS. Females have longer QTc and suffer from syncope earlier than males. Risk of SCD in males is associated with boarder QRS complex and longer QTc, whereas risk of syncope is associated with longer PR interval in males and slower heart rate in females.