Ablation strategies for the management of symptomatic Brugada syndrome: A systematic review

Gilson C. Fernandes, Amanda Fernandes, Rhanderson Cardoso, Guilherme Nasi, Manuel Rivera, Raul Mitrani, Jeffrey J. Goldberger

Research output: Contribution to journalArticle

  • 2 Citations

Abstract

Background: Ablation approaches have been described for the management of symptomatic ventricular arrhythmias in patients with Brugada syndrome, but this treatment is still considered experimental. Objective: We aimed to perform a systematic review of the current evidence on the use of catheter ablation in Brugada syndrome. Methods: MEDLINE, Embase, and Scopus were searched for articles describing the use of catheter ablation for ventricular arrhythmia management in Brugada syndrome. Results: We included 11 case series and 11 case reports including a total of 233 patients. Ablation strategies included epicardial mapping with substrate modification (n = 180; 77.3%), endocardial-only mapping with substrate modification (n = 17; 7.3%), ventricular fibrillation (VF)–triggering premature ventricular complex ablation (n = 5; 2.1%), and mixed approaches (n = 31; 13.3%). During a 2.5- to 78-month follow-up period, the success rates in preventing ventricular tachycardia or VF (VT/VF) were 96.7%, 70.6%, and 80% with epicardial, endocardial, and triggering premature ventricular complex ablation approaches, respectively. Among patients who underwent both epicardial and endocardial mapping, there was no identifiable endocardial substrate in 92.9% of cases. Elimination of type 1 Brugada-pattern electrocardiogram was attained in 98.3% and 34.8% of the epicardial and endocardial ablation groups, respectively. VT/VF occurred in 7 of 9 patients (77.8%) who had persistent or recurrent J-ST elevation and in none of the 24 patients with complete resolution during follow-up. Pharmacologic provocation augmented the abnormal area. Conclusion: Epicardial substrate modification appears to be more effective than endocardial-only approach in preventing VT/VF. Persistent or recurrent J-ST elevation appears to represent a marker of failure of ablation. Ablation seems to be an acceptable strategy for patients with Brugada syndrome and VT/VF.

LanguageEnglish (US)
Pages1140-1147
Number of pages8
JournalHeart Rhythm
Volume15
Issue number8
DOIs
StatePublished - Aug 1 2018
Externally publishedYes

Fingerprint

Brugada Syndrome
Ventricular Tachycardia
Epicardial Mapping
Ventricular Premature Complexes
Catheter Ablation
Ventricular Fibrillation
Cardiac Arrhythmias
MEDLINE
Electrocardiography

Keywords

  • Brugada syndrome
  • Catheter ablation
  • Endocardium
  • Epicardial mapping
  • Premature ventricular complex
  • Substrate modification

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Fernandes, G. C., Fernandes, A., Cardoso, R., Nasi, G., Rivera, M., Mitrani, R., & Goldberger, J. J. (2018). Ablation strategies for the management of symptomatic Brugada syndrome: A systematic review. Heart Rhythm, 15(8), 1140-1147. https://doi.org/10.1016/j.hrthm.2018.03.019

Ablation strategies for the management of symptomatic Brugada syndrome : A systematic review. / Fernandes, Gilson C.; Fernandes, Amanda; Cardoso, Rhanderson; Nasi, Guilherme; Rivera, Manuel; Mitrani, Raul; Goldberger, Jeffrey J.

In: Heart Rhythm, Vol. 15, No. 8, 01.08.2018, p. 1140-1147.

Research output: Contribution to journalArticle

Fernandes, GC, Fernandes, A, Cardoso, R, Nasi, G, Rivera, M, Mitrani, R & Goldberger, JJ 2018, 'Ablation strategies for the management of symptomatic Brugada syndrome: A systematic review' Heart Rhythm, vol. 15, no. 8, pp. 1140-1147. https://doi.org/10.1016/j.hrthm.2018.03.019
Fernandes, Gilson C. ; Fernandes, Amanda ; Cardoso, Rhanderson ; Nasi, Guilherme ; Rivera, Manuel ; Mitrani, Raul ; Goldberger, Jeffrey J. / Ablation strategies for the management of symptomatic Brugada syndrome : A systematic review. In: Heart Rhythm. 2018 ; Vol. 15, No. 8. pp. 1140-1147.
@article{4a7ed8b28ad7452b82501b84bedfdb3c,
title = "Ablation strategies for the management of symptomatic Brugada syndrome: A systematic review",
abstract = "Background: Ablation approaches have been described for the management of symptomatic ventricular arrhythmias in patients with Brugada syndrome, but this treatment is still considered experimental. Objective: We aimed to perform a systematic review of the current evidence on the use of catheter ablation in Brugada syndrome. Methods: MEDLINE, Embase, and Scopus were searched for articles describing the use of catheter ablation for ventricular arrhythmia management in Brugada syndrome. Results: We included 11 case series and 11 case reports including a total of 233 patients. Ablation strategies included epicardial mapping with substrate modification (n = 180; 77.3{\%}), endocardial-only mapping with substrate modification (n = 17; 7.3{\%}), ventricular fibrillation (VF)–triggering premature ventricular complex ablation (n = 5; 2.1{\%}), and mixed approaches (n = 31; 13.3{\%}). During a 2.5- to 78-month follow-up period, the success rates in preventing ventricular tachycardia or VF (VT/VF) were 96.7{\%}, 70.6{\%}, and 80{\%} with epicardial, endocardial, and triggering premature ventricular complex ablation approaches, respectively. Among patients who underwent both epicardial and endocardial mapping, there was no identifiable endocardial substrate in 92.9{\%} of cases. Elimination of type 1 Brugada-pattern electrocardiogram was attained in 98.3{\%} and 34.8{\%} of the epicardial and endocardial ablation groups, respectively. VT/VF occurred in 7 of 9 patients (77.8{\%}) who had persistent or recurrent J-ST elevation and in none of the 24 patients with complete resolution during follow-up. Pharmacologic provocation augmented the abnormal area. Conclusion: Epicardial substrate modification appears to be more effective than endocardial-only approach in preventing VT/VF. Persistent or recurrent J-ST elevation appears to represent a marker of failure of ablation. Ablation seems to be an acceptable strategy for patients with Brugada syndrome and VT/VF.",
keywords = "Brugada syndrome, Catheter ablation, Endocardium, Epicardial mapping, Premature ventricular complex, Substrate modification",
author = "Fernandes, {Gilson C.} and Amanda Fernandes and Rhanderson Cardoso and Guilherme Nasi and Manuel Rivera and Raul Mitrani and Goldberger, {Jeffrey J.}",
year = "2018",
month = "8",
day = "1",
doi = "10.1016/j.hrthm.2018.03.019",
language = "English (US)",
volume = "15",
pages = "1140--1147",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",
number = "8",

}

TY - JOUR

T1 - Ablation strategies for the management of symptomatic Brugada syndrome

T2 - Heart Rhythm

AU - Fernandes, Gilson C.

AU - Fernandes, Amanda

AU - Cardoso, Rhanderson

AU - Nasi, Guilherme

AU - Rivera, Manuel

AU - Mitrani, Raul

AU - Goldberger, Jeffrey J.

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Background: Ablation approaches have been described for the management of symptomatic ventricular arrhythmias in patients with Brugada syndrome, but this treatment is still considered experimental. Objective: We aimed to perform a systematic review of the current evidence on the use of catheter ablation in Brugada syndrome. Methods: MEDLINE, Embase, and Scopus were searched for articles describing the use of catheter ablation for ventricular arrhythmia management in Brugada syndrome. Results: We included 11 case series and 11 case reports including a total of 233 patients. Ablation strategies included epicardial mapping with substrate modification (n = 180; 77.3%), endocardial-only mapping with substrate modification (n = 17; 7.3%), ventricular fibrillation (VF)–triggering premature ventricular complex ablation (n = 5; 2.1%), and mixed approaches (n = 31; 13.3%). During a 2.5- to 78-month follow-up period, the success rates in preventing ventricular tachycardia or VF (VT/VF) were 96.7%, 70.6%, and 80% with epicardial, endocardial, and triggering premature ventricular complex ablation approaches, respectively. Among patients who underwent both epicardial and endocardial mapping, there was no identifiable endocardial substrate in 92.9% of cases. Elimination of type 1 Brugada-pattern electrocardiogram was attained in 98.3% and 34.8% of the epicardial and endocardial ablation groups, respectively. VT/VF occurred in 7 of 9 patients (77.8%) who had persistent or recurrent J-ST elevation and in none of the 24 patients with complete resolution during follow-up. Pharmacologic provocation augmented the abnormal area. Conclusion: Epicardial substrate modification appears to be more effective than endocardial-only approach in preventing VT/VF. Persistent or recurrent J-ST elevation appears to represent a marker of failure of ablation. Ablation seems to be an acceptable strategy for patients with Brugada syndrome and VT/VF.

AB - Background: Ablation approaches have been described for the management of symptomatic ventricular arrhythmias in patients with Brugada syndrome, but this treatment is still considered experimental. Objective: We aimed to perform a systematic review of the current evidence on the use of catheter ablation in Brugada syndrome. Methods: MEDLINE, Embase, and Scopus were searched for articles describing the use of catheter ablation for ventricular arrhythmia management in Brugada syndrome. Results: We included 11 case series and 11 case reports including a total of 233 patients. Ablation strategies included epicardial mapping with substrate modification (n = 180; 77.3%), endocardial-only mapping with substrate modification (n = 17; 7.3%), ventricular fibrillation (VF)–triggering premature ventricular complex ablation (n = 5; 2.1%), and mixed approaches (n = 31; 13.3%). During a 2.5- to 78-month follow-up period, the success rates in preventing ventricular tachycardia or VF (VT/VF) were 96.7%, 70.6%, and 80% with epicardial, endocardial, and triggering premature ventricular complex ablation approaches, respectively. Among patients who underwent both epicardial and endocardial mapping, there was no identifiable endocardial substrate in 92.9% of cases. Elimination of type 1 Brugada-pattern electrocardiogram was attained in 98.3% and 34.8% of the epicardial and endocardial ablation groups, respectively. VT/VF occurred in 7 of 9 patients (77.8%) who had persistent or recurrent J-ST elevation and in none of the 24 patients with complete resolution during follow-up. Pharmacologic provocation augmented the abnormal area. Conclusion: Epicardial substrate modification appears to be more effective than endocardial-only approach in preventing VT/VF. Persistent or recurrent J-ST elevation appears to represent a marker of failure of ablation. Ablation seems to be an acceptable strategy for patients with Brugada syndrome and VT/VF.

KW - Brugada syndrome

KW - Catheter ablation

KW - Endocardium

KW - Epicardial mapping

KW - Premature ventricular complex

KW - Substrate modification

UR - http://www.scopus.com/inward/record.url?scp=85049937485&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85049937485&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2018.03.019

DO - 10.1016/j.hrthm.2018.03.019

M3 - Article

VL - 15

SP - 1140

EP - 1147

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 8

ER -