e-Article
Long-Term Outcomes of Brugada Substrate Ablation: A Report from BRAVO (Brugada Ablation of VF Substrate Ongoing Multicenter Registry).
Document Type
Article
Author
Nademanee, Koonlawee; Chung, Fa-Po; Sacher, Frederic; Nogami, Akihiko; Nakagawa, Hiroshi; Jiang, Chenyang; Hocini, Meleze; Behr, Elijah; Veerakul, Gumpanart; Jan Smit, Jaap; Wilde, Arthur A.M.; Chen, Shih-Ann; Yamashiro, Kohei; Sakamoto, Yuichiro; Morishima, Itsuro; Das, Mithilesh K.; Khongphatthanayothin, Apichai; Vardhanabhuti, Saran; Haissaguerre, Michel
Source
Subject
*IMPLANTABLE cardioverter-defibrillators
*VENTRICULAR outflow obstruction
*BRUGADA syndrome
*VENTRICULAR fibrillation
*CATHETER ablation
*CARDIAC arrest
*PERICARDIUM
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Language
ISSN
0009-7322
Abstract
Background: Treatment options for high-risk Brugada syndrome (BrS) with recurrent ventricular fibrillation (VF) are limited. Catheter ablation is increasingly performed but a large study with long-term outcome data is lacking. We report the results of the multicenter, international BRAVO (Brugada Ablation of VF Substrate Ongoing Registry) for treatment of high-risk symptomatic BrS. Methods: We enrolled 159 patients (median age 42 years; 156 male) with BrS and spontaneous VF in BRAVO; 43 (27%) of them had BrS and early repolarization pattern. All but 5 had an implantable cardioverter-defibrillator for cardiac arrest (n=125) or syncope (n=34). A total of 140 (88%) had experienced numerous implantable cardioverter-defibrillator shocks for spontaneous VF before ablation. All patients underwent a percutaneous epicardial substrate ablation with electroanatomical mapping except for 8 who underwent open-thoracotomy ablation. Results: In all patients, VF/BrS substrates were recorded in the epicardial surface of the right ventricular outflow tract; 45 (29%) patients also had an arrhythmic substrate in the inferior right ventricular epicardium and 3 in the posterior left ventricular epicardium. After a single ablation procedure, 128 of 159 (81%) patients remained free of VF recurrence; this number increased to 153 (96%) after a repeated procedure (mean 1.2±0.5 procedures; median=1), with a mean follow-up period of 48±29 months from the last ablation. VF burden and frequency of shocks decreased significantly from 1.1±2.1 per month before ablation to 0.003±0.14 per month after the last ablation (P <0.0001). The Kaplan-Meier VF-free survival beyond 5 years after the last ablation was 95%. The only variable associated with a VF-free outcome in multivariable analysis was normalization of the type 1 Brugada ECG, both with and without sodium-channel blockade, after the ablation (hazard ratio, 0.078 [95% CI, 0.008 to 0.753]; P =0.0274). There were no arrhythmic or cardiac deaths. Complications included hemopericardium in 4 (2.5%) patients. Conclusions: Ablation treatment is safe and highly effective in preventing VF recurrence in high-risk BrS. Prospective studies are needed to determine whether it can be an alternative treatment to implantable cardioverter-defibrillator implantation for selected patients with BrS. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04420078. [ABSTRACT FROM AUTHOR]