Catheter Ablation for Atrial Fibrillation in Patients with Brugada
Syndrome with Atrial Fibrillation to Reduce Inappropriate Shock and
Anti-Arrhythmic Drug Use
Abstract
Background: Atrial fibrillation (AF) is a prevalent arrhythmia in
patients with Brugada Syndrome (BrS) and increases the risk of major
arrhythmic events (MAE) and inappropriate ICD shock. The use of
antiarrhythmic drugs (AAD) for rhythm control is often limited in this
population. Objective: We aimed to assess the safety and efficacy of
catheter ablation (CA) for AF in BrS patients with AF. Methods: A
systemic search of databases, including PubMed, EMBASE, SCOPUS, Google
Scholar, was conducted. Random effect model was used to evaluate pooled
incidences of outcomes with 95% confidence interval (CI), including (1)
freedom from atrial arrhythmias (AA) after index and last ablation, (2)
patients requiring redo-ablation, (3) freedom from AAD, (4)
inappropriate shocks, and (5) complications. Results: Five studies with
a total of 58 BrS patients with AF undergoing AF ablation were analyzed
(71% men, mean age 49.8±16.5 years, 76% with ICD, 98.3% paroxysmal
AF, 25.9% spontaneous type-1, 33.3% positive SCN5A mutation, 13.8%
with previous MAE). Prior to ablation, 65% of patients with ICD had
experienced inappropriate shocks. At a mean follow-up period of 32.7 ±
21.5 months after the index ablation, the freedom from AA after the
index and repeated ablation was 70% (95%CI 59-82%) and 92% (95%CI
82-100%), respectively. Redo-ablation was needed in 19% (95%CI
3-34%) of patients, with 73% of these cases involving pulmonary vein
reconnection. Freedom from AAD use after the repeated ablation was 91%
(95%CI 79-100%). No patients experienced inappropriate ICD shock after
AF ablation (0%), and the procedural complication rate was 2.1%
(95%CI 0-7.9%). Conclusions: Catheter ablation for AF in BrS patients
is safe, highly effective, and associated with reduced inappropriate
shocks and AAD use.