Key result
Catheter ablation linked to ~90% lower VF and SCD risk vs ICD in symptomatic Brugada syndrome.
Why the study?
The study investigated the outcomes of catheter ablation in preventing arrhythmic events among patients with symptomatic Brugada syndrome who declined ICD implantation.
Does catheter ablation reduce episodes of ventricular fibrillation and sudden cardiac death compared to ICD implantation in high-risk patients with symptomatic Brugada syndrome?
Cohort (n=40)
Does catheter ablation reduce episodes of ventricular fibrillation and sudden cardiac death compared to ICD implantation in high-risk patients with symptomatic Brugada syndrome?
Absolute Event Rate: 5.6% vs 54.5%
p-value: p=0.012
Catheter ablation may be an effective alternative therapy for improving arrhythmic outcomes in high-risk patients with symptomatic Brugada syndrome who decline ICD implantation.
May support ablation as alternative in symptomatic Brugada declining ICD; leaves open need for randomized confirmation.
AIMS: The aim of this study was to investigate the outcomes of catheter ablation (CA) in preventing arrhythmic events among patients with symptomatic Brugada syndrome (BrS) who declined implantable cardioverter defibrillator (ICD) implantation. METHODS AND RESULTS: A total of 40 patients with symptomatic BrS were included in the study, of which 18 refused ICD implantation and underwent CA, while 22 patients received ICD implantation. The study employed substrate modification (including endocardial and epicardial approaches) and ventricular fibrillation (VF)-triggering pre-mature ventricular contraction (PVC) ablation strategies. The primary outcomes were a composite endpoint consisting of episodes of VF and sudden cardiac death during the follow-up period. The study population had a mean age of 43.8 ± 9.6 years, with 36 (90.0%) of them being male. All patients exhibited the typical Type 1 BrS electrocardiogram pattern, and 16 (40.0%) were carriers of an SCN5A mutation. The Shanghai risk scores were comparable between the CA and the ICD groups (7.05 ± 0.80 vs. 6.71 ± 0.86, P = 0.351). Ventricular fibrillation-triggering PVCs were ablated in 3 patients (16.7%), while VF substrates were ablated in 15 patients (83.3%). Epicardial ablation was performed in 12 patients (66.7%). During a median follow-up of 46.2 (17.5-73.7) months, the primary outcomes occurred more frequently in the ICD group than in the CA group (5.6 vs. 54.5%, Log-rank P = 0.012). CONCLUSION: Catheter ablation is an effective alternative therapy for improving arrhythmic outcomes in patients with symptomatic BrS who decline ICD implantation. Our findings support the consideration of CA as an alternative treatment option in this population.
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Li et al. (2023) conducted a cohort in Symptomatic Brugada syndrome (n=40). Catheter ablation vs. Implantable cardioverter defibrillator (ICD) implantation was evaluated on Composite endpoint consisting of episodes of VF and sudden cardiac death (p=0.012). Catheter ablation was associated with a significantly lower rate of ventricular fibrillation and sudden cardiac death compared to ICD implantation in symptomatic Brugada syndrome (5.6% vs 54.5%, P=0.012).