Epicardial Substrate Ablation for Brugada Syndrome with frequent ICD Shocks: Short and Mid-term Outcomes
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Tóm tắt
Background: While implantable cardioverter defibrillator (ICD) remains the cornerstone therapy for high-risk Brugada syndrome patients, recurrent ventricular arrhythmias and frequent ICD shocks can significantly impair their quality of life. Epicardial substrate ablation targeting abnormal electrograms has been reported as a potential therapeutic option for these patients. This study aims to evaluate the feasibility, safety and outcomes of epicardial substrate ablation in patients with Brugada syndrome experiencing recurrent ventricular arrhythmias and frequent ICD shocks.
Methods: We conducted a single-center retrospective study including patients with symptomatic type 1 Brugada syndrome who underwent ICD implantation at Hanoi Heart Hospital between 2016 and 2026. Among them, patients who experienced recurrent appropriate ICD shocks despite medical therapy and subsequently underwent epicardial catheter ablation were included. Electroanatomical mapping was performed using a three-dimensional mapping system to identify abnormal epicardial substrates. Radiofrequency ablation was delivered to eliminate these substrates. Procedural characteristics, complications, and follow-up outcomes were analyzed.
Results: 11 male patients (mean age 46.18 ± 14.43 years) underwent epicardial ablation. Successful epicardial access was achieved in all cases. The mean procedure time was 172.4 ± 12.8 minutes. The anterior RVOT was the primary ablation target in all patients, with additional lateral or inferolateral substrate identified in some cases. During a median follow-up of 39 (7–78) months, ventricular arrhythmia recurrence occurred in three patients (27.3%), and repeat ablation was required in two (18.2%). 8 patients (72.7%) remained free of ICD shocks. One patient developed pericarditis requiring pericardiocentesis, and one developed ICD infection during follow-up.
Conclusion: Epicardial substrate ablation appears to be a feasible and safe strategy for reducing ventricular arrhythmia burden and ICD shocks in patients with Brugada syndrome. Larger studies are needed to confirm its long-term efficacy.
Từ khóa
Brugada syndrome, recurrent ICD shock, radiofrequency ablation, epicardial access
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Tài liệu tham khảo
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