Long‐term outcomes of pulmonary vein isolation in patients with Brugada Syndrome and paroxysmal atrial fibrillation

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

2. Rates of freedom from AF were similar between BrS and non-BrS patients with a history of paroxysmal AF.

3. Rates of inappropriate shocks from implantable cardioverter-defibrillators (ICDs) were significantly lower following PVI catheter ablation, compared to prior.

Evidence Rating Level: 2 (Good)

Atrial fibrillation (AF) is the most frequent supraventricular arrhythmia that occurs in patients with Brugada syndrome (BrS), an inherited arrhythmia syndrome. Pharmacological treatment for AF in BrS patients is complex due to a risk of drug-related ventricular arrhythmias. Catheter ablation is an option, which for BrS patients involves pulmonary vein isolation (PVI), although the pathophysiology of the condition is unclear regarding 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 ceases within 7 days, either with treatment or spontaneously. Each patient underwent PVI between 2012 and 2019 and was propensity-matched to a participant without BrS or structural heart disease, but with symptomatic paroxysmal AF treated with PVI. Antiarrhythmic medications were discontinued 3 months following ablation. The study showed that after a mean follow-up of 58.2±31.7 months, more non-BrS patients achieved freedom from atrial tachyarrhythmias, with 61.7% of BrS patients compared to 78.3% of non-BrS patients (log-rank p = 0.047). However, rates of freedom from AF were similar, with 76.7% of BrS patients and 83.3% of non-BrS patients (log-rank p = 0.27). Additionally, ICD-inappropriate shocks were less prevalent after ablation, with 27.6% reporting inappropriate shocks prior to ablation, and 3.4% afterwards (p = 0.01). Overall, this study demonstrated that BrS patients with AF did have a lower long-term rate of freedom from atrial tachyarrhythmias following PVI, compared to non-BrS AF patients, but that AF freedom rates were similar.

Click to read the study in JAHA

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