Efficacy and Safety of Radiofrequency Catheter Ablation in Brugada syndrome: A Systematic Review and Meta-Analysis

Radiofrequency catheter ablation (CA) has emerged as a therapeutic strategy for Brugada syndrome (BrS), particularly for patients with recurrent ventricular fibrillation (VF) and implantable cardioverter-defibrillator (ICD) shocks. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of CA compared with standard management. PubMed, Embase, and Scopus were searched from inception to August 2025 for randomized controlled trials and adjusted observational studies enrolling BrS patients undergoing CA versus ICD-only therapy, pharmacotherapy, or observation. Five studies (2 RCTs, 3 cohorts) comprising 510 patients (296 ablation; 214 control) were included. The primary outcome was ventricular arrhythmia recurrence; secondary outcomes were procedural complications and ICD-related complications. Pooled analysis demonstrated that CA significantly reduced ventricular arrhythmia recurrence (RR 0.20; 95% CI 0.05-0.75; P=0.02), with consistent benefit in randomized trials. No significant differences were observed in procedural complications (RR 0.81; 95% CI 0.32-2.01; P=0.65) or ICD-related complications (RR 1.16; 95% CI 0.49-2.78; P=0.73). Certainty of evidence ranged from moderate to very low based on GRADE. In conclusion, CA is an effective intervention for reducing recurrent ventricular arrhythmias in BrS without an increase in procedural or device-related adverse events. These findings support the expanding role of substrate-based ablation as a disease-modifying therapy in appropriately selected BrS patients.