EPICARDIAL ABLATION IN PATIENTS WITH BRUGADA SYNDROME: A SINGLE CENTRE EXPERIENCE

Aim: Retrospective analysis of the results of catheter ablation by epicardial approach and genetic testing in patients with a diagnosis of Brugada syndrome (BrS) and repeated adequate ICD interventions.

Sample and Methodology: In 2013-2024, catheter ablation by epicardial approach was performed in our centre in 9 patients diagnosed with BrS (mean age 41±6 years, nine males). All patients had an ICD implanted for secondary prevention of sudden cardiac death and presented with adequate ICD therapies (mean 9±11 shocks/patient in the last six months before catheter ablation). Patients underwent cardiogenetic testing.

Results: Type 1 electrocardiogram (ECG) pattern was present at baseline ECG in four (44%) patients; in five (56%) patients, type 1 was induced after ajmaline administration. Genetic testing was performed in seven patients, and only one patient (14%) was found to have a pathogenic mutation in the SCN5A gene. Prior to ablation, sustained ventricular tachycardia (VT)/ventricular fibrillation (VF) could be induced by programmed ventricular stimulation (PVS) in three patients (33%). Epicardial ablation targeted at abnormal electrograms located over the right ventricular outflow tract. No complications were noted. The mean follow-up was 25±30 months. In one patient (11%), reablation was required to suppress ventricular arrhythmias (VA) successfully. After the last ablation, no recurrence of VT/VF was observed in any patient.

Conclusions: Epicardial ablation is an effective method that leads to the suppression of VA in patients with a diagnosis of BrS and repeated ICD interventions. Despite the malignant arrhythmic phenotype, patients in our cohort had a rather low prevalence of signs associated with a high risk of VT/VF, such as spontaneous ECG pattern of BrS, inducibility of VT/VF during PVS, or the presence of a causative genetic mutation.