Key result
Sodium channel blocker-guided epicardial RF ablation shows promise as an ICD alternative in Brugada syndrome.
Why the study?
Therapeutic options in symptomatic Brugada syndrome are limited to ICD and quinidine, while catheter ablation of the RVOT offers a potential cure, with different ablation strategies being utilized.
Does epicardial catheter ablation prevent ventricular arrhythmias in patients with symptomatic Brugada syndrome?
Does epicardial catheter ablation prevent ventricular arrhythmias in patients with symptomatic Brugada syndrome?
Epicardial radiofrequency substrate ablation guided by sodium channel blocker infusion is a promising strategy for managing symptomatic Brugada syndrome and may potentially serve as an alternative to ICD therapy.
Answers are grounded in this paper and cite their sources.
May reduce ICD dependence in symptomatic Brugada syndrome; leaves open need for randomized trials to confirm arrhythmia prevention.
Introduction: Brugada syndrome (BrS) is an inherited disease characterized by an increased risk of sudden cardiac death (SCD). Therapeutic options in symptomatic patients are limited to implantable cardioverter defibrillator (ICD) and quinidine, but catheter ablation of the right ventricular outflow tract (RVOT) offers a potential cure. Different ablation strategies have been used to treat patients with symptomatic Brugada syndrome. Epicardial radiofrequency substrate ablation of the RVOT/right ventricle (RV) has emerged as a promising tool for the management of the disease.Areas covered: The historical management of BrS, endocardial and epicardial ablation techniques, the use of sodium channel blockers (SCB) and complications are summarized here.Expert opinion: Ventricular fibrillation (VF)-triggering premature ventricular contractions (PVCs) in patients with BrS are unpredictable, spontaneous ones are rarely present to be mapped, making this approach impractical. Furthermore, endocardial mapping for BrS substrates does not seem effective due to the epicardial pathological substrate localization. The size variation of the BrS substrate areas during SCB infusion suggests a dynamic process as arrhythmogenic basis and SCB infusion should guide BrS epicardial ablation of all abnormal potentials areas. If BrS epicardial ablation can truly provide long-term prevention of ventricular arrhythmias it may potentially become an alternative to ICD therapy.
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Rizzo et al. (2020) conducted a review in Brugada syndrome. Epicardial radiofrequency substrate ablation was evaluated. Epicardial radiofrequency substrate ablation guided by sodium channel blocker infusion is a promising tool for managing Brugada syndrome and may potentially become an alternative to ICD therapy.
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