Key result
PVI in Brugada syndrome is linked to ~17% lower freedom from atrial tachyarrhythmias versus controls.
Why the study?
Pharmacological AF treatment in Brugada syndrome is challenging, ICD patients risk inappropriate shocks, and long-term pulmonary vein isolation outcomes in this population remain poorly established.
Does pulmonary vein isolation with cryoballoon catheter ablation improve freedom from atrial tachyarrhythmias in patients with Brugada syndrome and paroxysmal AF compared to matched patients without Brugada syndrome?
Cohort (n=120)
Does pulmonary vein isolation with cryoballoon catheter ablation improve freedom from atrial tachyarrhythmias in patients with Brugada syndrome and paroxysmal AF compared to matched patients without Brugada syndrome?
Although patients with Brugada syndrome have higher rates of atrial tachyarrhythmia recurrence after pulmonary vein isolation compared to those without, the procedure significantly reduces inappropriate ICD shocks.
Warrants caution counseling Brugada syndrome patients on PVI expectations; leaves open need for randomized efficacy trials.
Background Pharmacological treatment of atrial fibrillation (AF) in the setting of Brugada syndrome (BrS) is challenging. In addition, patients with BrS with an implantable cardioverter‐defibrillator (ICD) might experience inappropriate shocks for fast AF. Long‐term outcome of pulmonary vein isolation in BrS has not been well established yet, and it is still unclear whether pulmonary vein triggers are the only pathophysiological mechanism of AF in BrS. The aim of the study is to assess the long‐term outcomes in patients with BrS undergoing pulmonary vein isolation for paroxysmal AF compared with a matched cohort of patients without BrS. Methods and Results Sixty patients with BrS undergoing pulmonary vein isolation with cryoballoon catheter ablation for paroxysmal AF were matched with 60 patients without BrS, who underwent the same procedure. After a mean follow‐up of 58.2±31.7 months, freedom from atrial tachyarrhythmias was achieved in 61.7% in the BrS group and in 78.3% in the non‐BrS group (log‐rank P =0.047). In particular, freedom from AF was 76.7% in the first group and in 83.3% in the second ( P =0.27), while freedom from atrial tachycardia/atrial flutter was 85% and 95% ( P =0.057). In the BrS group, 29 patients (48.3%) had an ICD and 8 (27.6%) had a previous ICD‐inappropriate shock for fast AF. In the BrS cohort, ICD‐inappropriate interventions for AF were significantly reduced after ablation (3.4% versus 27.6%; P =0.01). Conclusions Pulmonary vein isolation in patients with BrS was associated with higher rate of arrhythmic recurrence. Despite this, catheter ablation significantly reduced inappropriate ICD interventions in BrS patients and can be considered a therapeutic strategy to prevent inappropriate device therapies.
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Bisignani et al. (2022) conducted a cohort in Brugada syndrome and paroxysmal atrial fibrillation (n=120). Pulmonary vein isolation with cryoballoon catheter ablation vs. Matched cohort of patients without Brugada syndrome undergoing the same procedure was evaluated on Freedom from atrial tachyarrhythmias (p=0.047). Pulmonary vein isolation in patients with Brugada syndrome was associated with lower freedom from atrial tachyarrhythmias compared to patients without Brugada syndrome (61.7% vs 78.3%; P=0.047).
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