Time to Benefit of Epicardial Ablation in Malignant Forms of Brugada Syndrome: A Reconstructed Individual Patient...

Brugada syndrome (BrS) significantly contributes to sudden cardiac death in otherwise healthy individuals, primarily due to life-threatening ventricular fibrillation (VF). Traditional treatment prevents SCD but does not eliminate the risk of recurrent VF episodes. Recent developments in catheter ablation techniques targeting the arrhythmogenic substrate in the right ventricular epicardium have emerged as promising alternatives; however, there is a lack of randomized controlled trials (RCTs). To address this, we conducted a reconstructed individual patient data (IPD) meta-analysis to synthesize RCT evidence and estimate the time to benefit (TTB) of epicardial ablation in malignant BrS.

We systematically searched major databases for RCTs comparing epicardial ablation versus ICD only in patients with malignant forms of BrS. IPD were reconstructed from Kaplan-Meier curves. Hazard ratios (HRs) and 95% confidence intervals (CI) were estimated using Cox regression, and Weibull models were applied to calculate TTB.

Two RCTs (Nademandee et al; and Pappone et al.) including 90 patients (mean age 43.5 years) were included. Epicardial ablation therapy reduced the risk of VF recurrence (HR 0.17; 95% CI: 0.07-0.43; p < 0.001). The TTB to prevent one VF per 100 patients was 0.2 months (97.5% CI: 0.1-8.1 months).

In patients with malignant forms of BrS, epicardial ablation was linked to a reduction in VF. These findings indicate that, for selected patients, adjunctive ablation procedures may provide a more favorable benefit profile than relying solely on ICDs.