Long-term outcomes of pulmonary vein isolation in patients with Brugada syndrome and paroxysmal atrial fibrillation

1. At 58 months of follow-up, fewer patients with Brugada syndrome (BrS) and associated paroxysmal atrial fibrillation (AF) achieved freedom from atrial tachyarrhythmias, after pulmonary venous isolation (PVI) catheter ablation, compared to non-BrS patients with paroxysmal AF.

2. The degrees of freedom from AF were comparable between BrS and non-BrS patients with a history of paroxysmal AF.

3. The rates of inappropriate shocks from implantable cardioverter-defibrillators (ICDs) were significantly lower after PVI catheter ablation compared to before.

Evidence Rating Level: 2 (Good)

Atrial fibrillation (AF) is the most common supraventricular arrhythmia that occurs in patients with Brugada syndrome (BrS), a hereditary arrhythmia syndrome. Pharmacological treatment of AF in BrS patients is complex due to a risk of drug-related ventricular arrhythmias. Catheter ablation is an option, which includes pulmonary vein isolation (PVI) for BrS patients, although the pathophysiology of the condition is unclear whether pulmonary veins are an appropriate target. Therefore, this cohort study examined the long-term outcomes of PVI in BrS patients with paroxysmal AF compared to AF patients without BrS, including freedom from atrial tachyarrhythmias and prevalence of inappropriate shocks from implantable cardioverter-defibrillators (ICDs). The study population consisted of 60 BrS patients with paroxysmal AF, or AF that stops within 7 days, either on treatment or spontaneously. Each patient underwent PVI between 2012 and 2019 and was matched with a participant without BrS or structural heart disease, but with symptomatic paroxysmal AF treated with PVI. Antiarrhythmic medication was discontinued 3 months after ablation. The study showed that after a mean follow-up of 58.2 ± 31.7 months, more non-BrS patients were free of atrial tachyarrhythmias, with 61.7% of BrS patients compared to 78.3% of BrS patients. the non-BrS patients (log-rank p = 0.047). However, the degree of freedom from AF was similar, with 76.7% of BrS patients and 83.3% of non-BrS patients (log-rank p = 0.27). In addition, ICD inappropriate shocks were less frequent after ablation: 27.6% reported inappropriate shocks before ablation and 3.4% after (p = 0.01). Overall, this study showed that BrS patients with AF after PVI had a lower long-term freedom from atrial tachyarrhythmias, compared to non-BrS AF patients, but AF freedom rates were comparable.

Click to read the study in JAHA

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