Epicardial ablation successful in Brugada syndrome

Compared with implantable cardioverter-defibrillator (ICD) therapy alone, arrhythmogenic substrate ablation plus ICD therapy reduced the burden of ventricular tachycardia (VT) and ventricular fibrillation (VF) in patients with Brugada syndrome.

“Epicardial electrical abnormalities represent the hallmark phenotype signature of Brugada syndrome,” explained Prof. Carlo Pappone (Vita-Salute San Raffaele University, Italy). The current trial enrolled 37 patients with Brugada syndrome who had a prior cardiac arrest or had at least 1 ICD therapy to compare ICD therapy alone with ICD therapy plus epicardial catheter ablation of the arrhythmogenic substrate or ‘Brugada substrate’ (NCT03294278) [1]. The participants were randomised 2:1 to the experimental condition or ICD alone. The recurrence of VT/VF was the primary outcome of the trial.

After a median follow-up of 30.5 months, 43% of the patients in the ICD group experienced VT/VF recurrence compared with only 5% in the ablation arm (P<0.001). There were 7 participants who had major ICD-related complications: 2 inappropriate shocks due to supraventricular tachycardia, 4 ICD lead malfunctions, and 1 device infection. Furthermore, 2 cases were reported of pericarditis with pericardial effusion.

Prof. Pappone concluded that catheter ablation is a safe procedure for patients with Brugada syndrome who are at risk of sudden death. Furthermore, arrhythmogenic substrate ablation decreased VT/VF recurrences in these patients, preventing recurrent ICD therapies. “The discovery of the so-called ‘Brugada syndrome’ opens avenues enabling further therapeutic strategies,” decided Prof. Pappone.

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   1. Pappone C, et al. Epicardial catheter ablation to prevent sudden death in Brugada syndrome: a randomized clinical trial. Late-Breaking Science – Today and Tomorrow, EHRA 2023, 16–18 April, Barcelona, Spain.

 

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Posted on 3 May 202315 February 2024