Pulmonary Vein Isolation for Atrial Fibrillation in Brugada Syndrome: A Meta-Analysis

Brugada syndrome (BrS) is an inherited arrhythmogenic disorder responsible for approximately 4% of sudden cardiac deaths. Atrial fibrillation (AF) frequently coexists and increases the risk of inappropriate implantable cardioverter-defibrillator (ICD) therapies. Antiarrhythmic drugs are often limited by proarrhythmic effects, creating an unmet therapeutic need.

We evaluated whether pulmonary vein isolation (PVI) reduces AF recurrence and provides effective rhythm control in patients with BrS and AF.

We conducted a systematic review and meta-analysis of studies published in PubMed, Embase, Web of Science, and Scopus from inception until February 14, 2026. We included studies reporting outcomes of PVI in patients with BrS and AF. The primary endpoint was freedom from AF after ablation. Secondary endpoints included AF recurrence, changes in inappropriate implantable cardioverter-defibrillator shocks before versus after ablation, and procedural complications. Pooled proportions and risk differences were calculated using random-effects models.

A total of 2149 records were initially identified. After screening and eligibility assessment, Five studies comprising 214 participants overall, including 124 patients with BrS or Brugada-type ECG, were included in the final analysis. The mean age of participants ranged from 45.8 ± 15.5 to 57 ± 10 years, and the proportion of male patients ranged from 33.3% to 100% across studies. PVI significantly reduced inappropriate defibrillator shocks (pooled risk difference -0.35). Freedom from AF was achieved in 82% of patients. The pooled recurrence rate was 36%. A spontaneous type 1 electrocardiographic pattern was present in 10% of patients, and 32% had a family history of sudden cardiac death. Procedural complications were uncommon across studies.

PVI was associated with favorable rhythm-control outcomes and acceptable procedural safety in patients with BrS or Brugada-type ECG and AF. Inappropriate ICD shocks were less frequent after ablation, supporting PVI as a clinically relevant rhythm-control strategy in this challenging population. Larger prospective studies are warranted to confirm these findings.