In patients with Brugada syndrome. arrhythmogenic substrate ablation plus implantable cardioverter-defibrillator (ICD) therapy reduced the burden of ventricular tachycardia (VT) and ventricular fibrillation (VF), compared with ICD therapy alone.

Carlo Pappone, MD, PhD, FACC

“Epicardial electrical abnormalities represent the hallmark phenotype signature of Brugada syndrome,” explained Carlo Pappone, MD, PhD, FACC, who presented his findings at the 2023 European Heart Rhythm Association (EHRA) Congress, held from April 16-18, in Barcelona, Spain¹.

A total of 37 patients were enrolled in the trial. All had Brugada syndrome with a prior cardiac arrest or at least one ICD therapy to compare ICD therapy alone with ICD therapy plus epicardial catheter ablation of the arrhythmogenic substrate or Brugada substrata. Patients were randomized 2:1 to the ICD alone or to the experimental condition. The primary outcome of the trial was the recurrence of VT/VF.

More than 40% of patients in the ICD group experienced VT/VF recurrence, compared with only 5% in the ablation arm after a median follow-up of 30.5 months, (P<0.001). Seven patients had major ICD-related complications: two inappropriate shocks due to supraventricular tachycardia, four ICD lead malfunctions, and one device infection. Additionally, two cases of pericarditis with pericardial effusion were reported.

Dr. Pappone concluded that catheter ablation is safe for patients with Brugada syndrome who are at risk for sudden death. Furthermore, arrhythmogenic substrate ablation decreased the incidence of VT/VF in these patients, preventing recurrent ICD therapies. “The discovery of the so-called ‘Brugada syndrome’ opens avenues enabling further therapeutic strategies,” he said.

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