Catheter ablation for monomorphic ventricular tachycardia in Brugada syndrome patients: detailed characteristics and long-term follow-up

Tokioka, Sayuri; Fukamizu, Seiji; Kitamura, Τakeshi; Miyazawa, Satoshi; Kawamura, Iwanari; Hojo, Rintaro; Sakurada, Harumizu; Hiraoka, Masayasu

doi:10.1007/s10840-019-00620-0

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…Tables 1 and 2 provide a comprehensive overview of the included studies, outlining their methodology, procedural characteristics, endpoints, and baseline data for study characteristics. It is important to note that the majority of the included studies primarily focused on BrS 9–11,13,14,16–19,21–24,26 . Procedurally, in determining the location of ablation on BrS, 11 studies used substrate‐based 9,10,13,14,16,18,19,21–23,26 and four studies used activation‐mapping guidance 11,17,23,24 .…”

Section: Resultsmentioning

confidence: 99%

“…It is important to note that the majority of the included studies primarily focused on BrS. 9 , 10 , 11 , 13 , 14 , 16 , 17 , 18 , 19 , 21 , 22 , 23 , 24 , 26 Procedurally, in determining the location of ablation on BrS, 11 studies used substrate‐based 9 , 10 , 13 , 14 , 16 , 18 , 19 , 21 , 22 , 23 , 26 and four studies used activation‐mapping guidance. 11 , 17 , 23 , 24 Whereas, in terms of the ablation approach, 10 studies in the BrS's population included outcome data for patients who received epicardial ablation, 9 , 10 , 13 , 14 , 16 , 17 , 18 , 19 , 21 , 26 seven studies included details of the outcomes of patients who received endocardial ablation 12 , 14 , 17 , 21 , 22 , 23 , 24 and two studies had patient outcomes for patients who received combined endocardial and epicardial ablation in one procedure.…”

Section: Resultsmentioning

confidence: 99%

“…[9][10][11]13,14,[16][17][18][19][21][22][23][24]26 Procedurally, in determining the location of ablation on BrS, 11 studies used substrate-based 9,10,13 ,14,16,18,19,21-23,26 and four studies used activation-mapping guidance. 11,17,23,24 Whereas, in terms of the ablation approach, 10 studies in the BrS's population included outcome data for patients who received epicardial ablation, 9,10,13,14,[16][17][18][19]21,26 seven studies included details of the outcomes of patients who received endocardial ablation 12,14,17,21-24 and two studies had patient outcomes for patients who received combined endocardial and epicardial ablation in one procedure. 14,21 In the population with LQTS, each study utilized a substrate-based and activation-mapping guidance ablation method, as well as an epicardial and endocardial ablation approach, with equal representation across the included studies.…”

Section: Selection and Description Of Studiesmentioning

confidence: 99%

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Future direction of substrate‐based catheter ablation in Brugada syndrome and other inherited primary arrhythmia syndromes: Systematic review and meta‐analysis

Prana Jagannatha,

Antara,

Kosasih

et al. 2023

Journal of Arrhythmia

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BackgroundInherited Primary Arrhythmias Syndromes (IPAS), especially Brugada syndrome (BrS), have been associated with arrhythmogenic substrates that can be targeted through ablation. This meta‐analysis evaluated the outcomes of catheter ablation (CA) in different types of IPAS based on procedural guidance and location.MethodsA systematic search was conducted across multiple databases to identify studies reporting on ventricular arrhythmia (VA) events before and after CA in IPAS, including BrS, Long‐QT syndrome (LQTS), Early repolarization syndrome (ERS), and Idiopathic ventricular fibrillation (IVF). The primary outcomes were VA recurrence and VA burden, evaluated through conditional subgroup analysis. Procedural data were collected as secondary outcomes.ResultsA total of 21 studies involving 584 IPAS patients who underwent CA were included. Following a mean follow‐up duration of 33.5 months, substrate‐based ablation demonstrated efficacy in reducing VA recurrence across all types of IPAS [RR 0.23; 95% CI (0.13–0.39); p < .001; I2 = 74%]. However, activation guidance ablation was found to be effective only in IVF cases. Although recurrences still occurred, CA was successful in reducing VA burden [MD –4.70; 95% CI (−6.11–(−3.29); p < .001; I2 = 74%]. The mean size of arrhythmogenic substrate was 15.70 cm2 [95% CI (12.34–19.99 cm2)], predominantly distributed in the epicardial right ventricular outflow tract (RVOT) in BrS cases and LQTS [Proportion 0.99; 95% CI (0.96–1.00) and Proportion 0.82; 95% CI ( 0.59–1.00), respectively].ConclusionSubstrate‐based CA has demonstrated effective prevention of VA and reduction in VA burden in IPAS cases.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Selection and Description Of Studiesmentioning

confidence: 99%

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Future direction of substrate‐based catheter ablation in Brugada syndrome and other inherited primary arrhythmia syndromes: Systematic review and meta‐analysis

Prana Jagannatha,

Antara,

Kosasih

et al. 2023

Journal of Arrhythmia

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“…Although BrS has primarily been associated with a structurally normal heart, there is growing evidence of minor structural changes including fibrosis in the RVOT [45]. Interestingly, two independent studies identified a small subset of patients with BrS who present with monomorphic VT, with RVOT origin being the most common, followed by bundle branch reentrant VT [46,47]. It is likely that the fibrosis in the RVOT seen on cardiac MRI in patients with BrS [45] favors the development of RVOT VT while the infrahisian conduction disease associated with SCN5A variants may predispose to bundle branch reentrant VT.…”

Section: Brugada Syndromementioning

confidence: 99%

Catheter Ablation for Channelopathies: When Is Less More?

Mehta,

Chandiramani,

Ghosh

et al. 2024

JCM

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Ventricular fibrillation (VF) is a common cause of sudden cardiac death in patients with channelopathies, particularly in the young population. Although pharmacological treatment, cardiac sympathectomy, and implantable cardioverter defibrillators (ICD) have been the mainstay in the management of VF in patients with channelopathies, they are associated with significant adverse effects and complications, leading to poor quality of life. Given these drawbacks, catheter ablation has been proposed as a therapeutic option for patients with channelopathies. Advances in imaging techniques and modern mapping technologies have enabled increased precision in identifying arrhythmia triggers and substrate modification. This has aided our understanding of the underlying pathophysiology of ventricular arrhythmias in channelopathies, highlighting the roles of the Purkinje network and the epicardial right ventricular outflow tract in arrhythmogenesis. This review explores the role of catheter ablation in managing the most common channelopathies (Brugada syndrome, congenital long QT syndrome, short QT syndrome, and catecholaminergic polymorphic ventricular tachycardia). While the initial results for ablation in Brugada syndrome are promising, the long-term efficacy and durability of ablation in different channelopathies require further investigation. Given the genetic and phenotypic heterogeneity of channelopathies, future studies are needed to show whether catheter ablation in patients with channelopathies is associated with a reduction in VF, and psychological distress stemming from recurrent ICD shocks, particularly relative to other available therapeutic options (e.g., quinidine in high-risk Brugada patients).

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Efficacy and safety of catheter ablation for Brugada syndrome: an updated systematic review

et al. 2022

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Background Patients with Brugada syndrome (BrS) may experience recurrent ventricular arrhythmias (VAs). Catheter ablation is becoming an emerging paradigm for treatment of BrS. Objective To assess the efficacy and safety of catheter ablation in BrS in an updated systematic review. Methods We comprehensively searched the databases of Pubmed/Medline, EMBASE, and Cochrane Central Register of Controlled Trials from inception to 11th of August 2021. Results Fifty-six studies involving 388 patients were included. A substrate-based strategy was used in 338 cases (87%), and a strategy of targeting premature ventricular complex (PVCs)/ventricular tachycardias (VTs) that triggered ventricular fibrillation (VF) in 47 cases (12%), with combined abnormal electrogram and PVC/VT ablation in 3 cases (1%). Sodium channel blocker was frequently used to augment the arrhythmogenic substrate in 309/388 cases (80%), which included a variety of agents, of which ajmaline was most commonly used. After ablation procedure, the pooled incidence of non-inducibility of VA was 87.1% (95% confidence interval [CI], 73.4–94.3; I2 = 51%), and acute resolution of type I ECG was seen in 74.5% (95% CI [52.3–88.6]; I2 = 75%). Over a weighted mean follow up of 28 months, 7.6% (95% CI [2.1–24]; I2 = 67%) had recurrence of type I ECG either spontaneously or with drug challenge and 17.6% (95% CI [10.2–28.6]; I2 = 60%) had recurrence of VA. Conclusion Catheter ablation appears to be an efficacious strategy for elimination of arrhythmias or substrate associated with BrS. Further study is needed to identify which patients stand to benefit, and optimal provocation protocol for identifying ablation targets. Graphical abstract

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Catheter ablation for monomorphic ventricular tachycardia in Brugada syndrome patients: detailed characteristics and long-term follow-up

Cited by 5 publications

References 19 publications

Future direction of substrate‐based catheter ablation in Brugada syndrome and other inherited primary arrhythmia syndromes: Systematic review and meta‐analysis

Future direction of substrate‐based catheter ablation in Brugada syndrome and other inherited primary arrhythmia syndromes: Systematic review and meta‐analysis

Catheter Ablation for Channelopathies: When Is Less More?

Efficacy and safety of catheter ablation for Brugada syndrome: an updated systematic review

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