Heart rhythm · 2025
Epicardial substrate ablation in patients with symptomatic Brugada syndrome: An updated systematic review and single-arm meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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Karlinski Vizentin Vanessa, Ferreira Felix Iuri, Pivato da Fonseca Rafaela, Bozko Collini Michelle, Pinheiro Braga Marcelo Antonio, Serafim Dagostin Caroline, Vidal Armaganijan Luciana, Ackerman Michael J, Dantas Brígido Alexandra Régia, Dagostin de Carvalho Guilherme
Аннотация
BACKGROUND: Brugada syndrome (BrS) is a genetic heart disease that predisposes individuals to ventricular arrhythmias and sudden cardiac death. Although implantable cardioverter-defibrillators (ICDs) and quinidine are primary treatments, recurrent BrS-triggered ventricular arrhythmias can persist. In this setting, epicardial substrate ablation has emerged as a promising alternative for symptomatic patients.
OBJECTIVE: Evaluate the effectiveness and safety of epicardial substrate ablation in patients with BrS.
METHODS: In this single-arm meta-analysis, we systematically searched PubMed, Embase, and Cochrane databases following PRISMA guidelines for studies including BrS patients with epicardial substrate ablation. Data were extracted, and statistical analysis was performed using random-effects modeling for proportional meta-analysis.
RESULTS: Thirteen cohort studies comprising 555 BrS patients were included. The mean age at enrollment was 42.6 ± 12.3 years; 82.7% were male patients, and 50% exhibited spontaneous type 1 Brugada electrocardiographic (ECG) pattern. Pooled analysis demonstrated resolution of the type 1 pattern in 91% of the cases (95% confidence interval [CI] 80-98%; I2 = 86%) and elimination of abnormal electrograms in 91% (95% CI 78-99%; I2 = 74%). Rates of recurrent VT/VF and appropriate ICD therapies during postablation follow-up were 12% (95% CI 4-21%; I2 = 86%) and 8% (95% CI 2-18%; I2 = 87%), respectively.
CONCLUSION: Epicardial substrate ablation shows promise for patients with BrS experiencing BrS-triggered ventricular arrhythmias, offering therapeutic efficacy with an acceptable safety profile. High heterogeneity among studies highlights the need for further research and standardized protocols.
OBJECTIVE: Evaluate the effectiveness and safety of epicardial substrate ablation in patients with BrS.
METHODS: In this single-arm meta-analysis, we systematically searched PubMed, Embase, and Cochrane databases following PRISMA guidelines for studies including BrS patients with epicardial substrate ablation. Data were extracted, and statistical analysis was performed using random-effects modeling for proportional meta-analysis.
RESULTS: Thirteen cohort studies comprising 555 BrS patients were included. The mean age at enrollment was 42.6 ± 12.3 years; 82.7% were male patients, and 50% exhibited spontaneous type 1 Brugada electrocardiographic (ECG) pattern. Pooled analysis demonstrated resolution of the type 1 pattern in 91% of the cases (95% confidence interval [CI] 80-98%; I2 = 86%) and elimination of abnormal electrograms in 91% (95% CI 78-99%; I2 = 74%). Rates of recurrent VT/VF and appropriate ICD therapies during postablation follow-up were 12% (95% CI 4-21%; I2 = 86%) and 8% (95% CI 2-18%; I2 = 87%), respectively.
CONCLUSION: Epicardial substrate ablation shows promise for patients with BrS experiencing BrS-triggered ventricular arrhythmias, offering therapeutic efficacy with an acceptable safety profile. High heterogeneity among studies highlights the need for further research and standardized protocols.