Key result
Epicardial ablation in high-risk Brugada syndrome is linked to ~95% fewer annual ICD shocks.
Why the study?
VF development in Brugada syndrome is associated with several ECG abnormalities, but changes in ECG parameters in high-risk patients undergoing epicardial catheter ablation had not been fully investigated.
Does epicardial substrate catheter ablation improve electrocardiogram parameters and reduce ventricular fibrillation recurrence in high-risk Brugada syndrome patients?
Observational (n=27)
Does epicardial substrate catheter ablation improve electrocardiogram parameters and reduce ventricular fibrillation recurrence in high-risk Brugada syndrome patients?
Epicardial catheter ablation in high-risk Brugada syndrome patients significantly improves surface ECG parameters and markedly reduces the incidence of ICD shocks.
May reduce ICD shocks in high-risk Brugada syndrome; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Catheter ablation (CA) is effective for recurrent episodes of ventricular fibrillation (VF) in Brugada syndrome (BrS). VF development in BrS is associated with several electrocardiogram (ECG) abnormalities. This study investigated changes in ECG parameters in high-risk BrS patients who underwent epicardial CA. METHODS AND RESULTS: In all, 27 BrS patients were implanted with an implantable cardioverter-defibrillator (ICD). Patients were divided into 2 groups: (1) an ablation group (n=11) that underwent epicardial CA because of VF recurrence; and (2) a primary prevention (PP) group (n=16) with ICD implantation only. ECG parameters were evaluated before and 12 months after CA and compared with ECG parameters in the PP group. The T wave peak-to-end interval was significantly longer and the number of abnormal spikes in leads V1-V3 at the second, third, and fourth intercostal spaces was greater in the ablation than PP group. After ablation, ST levels and the sum of abnormal spikes in leads V1-V3 were significantly decreased. The mean (±SD) number of ICD shocks decreased markedly during a mean follow-up period of 42.0 months (from 3.8±3.7 to 0.2±0.4/year). Four patients had an ICD shock following the ablation procedure. Greater reductions in ST-segment elevation and abnormal spikes were observed in the group without than with VF recurrence. CONCLUSIONS: Improvements in surface ECG parameters appear to be associated with successful ablation in high-risk BrS patients.
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Mamiya et al. (2021) conducted an observational in Brugada syndrome (n=27). Epicardial substrate catheter ablation vs. ICD implantation only (primary prevention) was evaluated on Changes in ECG parameters and ICD shocks. Epicardial catheter ablation in high-risk Brugada syndrome patients significantly decreased ST levels, abnormal spikes, and mean ICD shocks from 3.8 to 0.2 per year.
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