Epicardial ablation in high-risk Brugada syndrome to prevent ventricular fibrillation: results from a randomized...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Brugada syndrome (BrS) poses a risk of ventricular fibrillation (VF), often managed with implantable cardioverter-defibrillators (ICDs).
• Epicardial ablation is a potential adjunctive therapy for BrS, but its efficacy requires validation through randomized trials.
• ClinicalTrials.gov Identifier: NCT03294278.

Purpose of the Study:

• To evaluate the efficacy and safety of epicardial catheter ablation in reducing VF recurrence in high-risk BrS patients.
• To compare outcomes between patients undergoing epicardial ablation and those receiving ICD therapy alone.

Main Methods:

• A prospective, single-centre, randomized (2:1) study enrolled 40 high-risk BrS patients with a history of cardiac arrest or appropriate ICD therapies.
• Patients were randomized to either epicardial ablation (n=26) or no ablation (control group, n=14), with all patients having an ICD.
• The primary endpoint was freedom from VF recurrence, with secondary endpoints including safety and quality of life.

Main Results:

• After a mean follow-up of 4.0 years, freedom from VF recurrence was significantly higher in the ablation group (96%) compared to the control group (50%) (P < 0.001).
• One patient (3.8%) in the ablation group experienced pericardial effusion requiring pericardiocentesis.
• Thirteen patients (33%) experienced major ICD-related complications during the study period.

Conclusions:

• Epicardial catheter ablation is associated with a significant reduction in VF recurrence in high-risk BrS patients.
• These findings support the consideration of epicardial ablation as an effective treatment strategy for selected BrS patients.
• The study highlights the potential of targeted ablation to improve outcomes in BrS management.