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 Goldberger

Research output: Contribution to journalArticlepeer-review

14 Scopus 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.

Original languageEnglish (US)
Pages (from-to)1140-1147
Number of pages8
JournalHeart Rhythm
Volume15
Issue number8
DOIs
StatePublished - Aug 1 2018

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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