Epicardial Substrate Ablation in Symptomatic Brugada Syndrome Patients: An Updated Systematic Review and Single-arm Meta-analysis

Vanessa Karlinski Vizentin; Iuri Ferreira Felix; Rafaela Pivato da Fonseca; Michelle Bozko Collini; Marcelo Antonio Pinheiro Braga; Caroline Serafim Dagostin; Luciana Vidal Armaganijan; Michael J Ackerman; Alexandra Régia Dantas Brígido; Guilherme Dagostin de Carvalho

doi:10.1016/j.hrthm.2025.01.006

Epicardial Substrate Ablation in Symptomatic Brugada Syndrome Patients: An Updated Systematic Review and Single-arm Meta-analysis

Heart Rhythm. 2025 Jan 10:S1547-5271(25)00020-7. doi: 10.1016/j.hrthm.2025.01.006. Online ahead of print.

Affiliations

¹ Mayo Clinic, Department of Cardiovascular Diseases, Rochester, MN, USA; Mayo Clinic, Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Rochester, MN, USA. Electronic address: karlinskivizentin.vanessa@mayo.edu.
² Mayo Clinic, Department of Medicine, Rochester, MN, USA.
³ Federal University of Rio Grande do Sul, Department of Medicine, Porto Alegre, Brazil.
⁴ Federal University of Parana, Department of Medicine, Curitiba, Brazil.
⁵ Federal University of Rio de Janeiro, Department of Medicine, Rio de Janeiro, Brazil.
⁶ University of the Extreme South of Santa Catarina, Department of Medicine, Criciuma, Santa Catarina, Brazil.
⁷ Dante Pazzanese Institute of Cardiology, Department of Electrophysiology, São Paulo, Brazil.
⁸ Mayo Clinic, Department of Cardiovascular Diseases, Rochester, MN, USA; Mayo Clinic, Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Rochester, MN, USA.
⁹ University of Sao Paulo Medical School, Department of Electrophysiology, São Paulo, Brazil.

PMID: 39800093
DOI: 10.1016/j.hrthm.2025.01.006

Abstract

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 was extracted, and statistical analysis was performed using random-effects modeling for proportional meta-analysis.

Results: 13 cohort studies comprising 555 BrS patients were included. The mean age at enrollment was 42.6 ± 12.3 years; 82.7% were males, and 50% exhibited spontaneous type 1 Brugada ECG pattern. Pooled analysis demonstrated resolution of the type 1 pattern in 91% of the cases (95% 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 post-ablation follow-up were 12% (95% CI 4-21%; I²=86%) and 8% (95% CI 2-18%; I²=87%), respectively.

Conclusions: Epicardial substrate ablation shows promise for BrS patients 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.

Keywords: Brugada Syndrome; Catheter Ablation; Epicardial Substrate; Genetic Heart Disease; Ventricular Arrhythmias.