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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1140-1147 |
| Number of pages | 8 |
| Journal | Heart Rhythm |
| Volume | 15 |
| Issue number | 8 |
| DOIs | |
| State | Published - Aug 1 2018 |
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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
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.
In: Heart Rhythm, Vol. 15, No. 8, 01.08.2018, p. 1140-1147.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Ablation strategies for the management of symptomatic Brugada syndrome
T2 - A systematic review
AU - Fernandes, Gilson C.
AU - Fernandes, Amanda
AU - Cardoso, Rhanderson
AU - Nasi, Guilherme
AU - Rivera, Manuel
AU - Mitrani, Raul
AU - Goldberger, Jeffrey
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 -