Ablation of atrial fibrillation in patients with Brugada syndrome: A systematic review of the literature

Abstract

Supraventricular arrhythmias are common in Brugada syndrome (BS), and notoriously difficult to manage with medical therapy secondary to associated risks. Pulmonary vein isolation (PVI) is often utilized instead, but its outcomes in this population are not well‐known. We aim to provide a holistic evaluation of interventional treatment for Atrial fibrillation (AF) in the BS population. Electronic databases Medline, Embase, Cinahl, Cochrane, and Scopus were systematically searched for publications between 01/01/1995 and 12/31/2017. Studies were screened based on predefined inclusion and exclusion criteria. A total of 49 patients with BS and AF were included. Age range from 28.8 to 64 years, and 77.5% were male. 38 patients were implanted with implantable cardioverter‐defibrillators (ICD) at baseline, and of them, 39% suffered inappropriate shocks for rapid AF. 34/49 (69%) of patients achieved remission following a single PVI procedure. Of the remaining, 13 patients underwent one or more repeat ablation procedures. Overall, 45/49 (91.8%) of patients remained in remission during long‐term follow‐up after one or more PVI procedures in the absence of antiarrhythmic drug (AAD) therapy. Postablation, no patients suffered inappropriate ICD shock. Furthermore, no major complications secondary to PVI occurred in any patient. AF ablation achieves acute and long‐term success in the vast majority of patients. It is effective in preventing inappropriate ICD therapy secondary to rapid AF. Complication rates of PVI in BS are low. Thus, in light of the risks of AADs and risk of inappropriate ICD shocks in the BS population, catheter ablation could represent an appropriate first‐line therapy for paroxysmal atrial fibrillation in BS patients.

Atrial Fibrillation-triggered Ventricular Fibrillation in a Patient with Early Repolarization Syndrome

“…A recent study suggested that ER was associated with lone AF ( 2 ). RFCA has also been reported to effectively maintain the sinus rhythm in Brugada syndrome patients with AF in several reports ( 11 , 12 ), however, the efficacy of RFCA for AF to maintain the sinus rhythm in patients with ERS has not yet been investigated. Further study will therefore be needed to validate the efficacy of RFCA for AF in patients with ERS.…”

Atrial fibrillation in Brugada syndrome: Current perspectives

“…One more strategy to reduce inappropriate ICD therapies is the ablation procedure using either cryoablation technology or radiofrequency ablation for PVI. Rodriguez‐Manero et al 77 demonstrated in their review article that (a) freedom from AF recurrence in paroxysmal AF patients with BrS after PVI is high, (b) PVI reduces the need for AADs, and (c) ablation decreases the incidence of inappropriate ICD therapies caused by AF 77 …”

“…Rodriguez-Manero et al 77 demonstrated in their review article that (a) freedom from AF recurrence in paroxysmal AF patients with BrS after PVI is high, (b) PVI reduces the need for AADs, and (c) ablation decreases the incidence of inappropriate ICD therapies caused by AF. 77…”