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Abstract：
The aim of this study was to investigate the outcomes of catheter ablation (CA) in preventing arrhythmic events among patients with symptomatic Brugada syndrome (BrS) who declined implantable cardioverter defibrillator (ICD) implantation.
A total of 40 patients with symptomatic BrS were included in the study, of which 18 refused ICD implantation and underwent CA, while 22 patients received ICD implantation. The study employed substrate modification (including endocardial and epicardial approaches) and ventricular fibrillation (VF)-triggering pre-mature ventricular contraction (PVC) ablation strategies. The primary outcomes were a composite endpoint consisting of episodes of VF and sudden cardiac death during the follow-up period. The study population had a mean age of 43.8 ± 9.6 years, with 36 (90.0%) of them being male. All patients exhibited the typical Type 1 BrS electrocardiogram pattern, and 16 (40.0%) were carriers of an SCN5A mutation. The Shanghai risk scores were comparable between the CA and the ICD groups (7.05 ± 0.80 vs. 6.71 ± 0.86, P = 0.351). Ventricular fibrillation-triggering PVCs were ablated in 3 patients (16.7%), while VF substrates were ablated in 15 patients (83.3%). Epicardial ablation was performed in 12 patients (66.7%). During a median follow-up of 46.2 (17.5-73.7) months, the primary outcomes occurred more frequently in the ICD group than in the CA group (5.6 vs. 54.5%, Log-rank P = 0.012).
Catheter ablation is an effective alternative therapy for improving arrhythmic outcomes in patients with symptomatic BrS who decline ICD implantation. Our findings support the consideration of CA as an alternative treatment option in this population.
A total of 40 patients with symptomatic BrS were included in the study, of which 18 refused ICD implantation and underwent CA, while 22 patients received ICD implantation. The study employed substrate modification (including endocardial and epicardial approaches) and ventricular fibrillation (VF)-triggering pre-mature ventricular contraction (PVC) ablation strategies. The primary outcomes were a composite endpoint consisting of episodes of VF and sudden cardiac death during the follow-up period. The study population had a mean age of 43.8 ± 9.6 years, with 36 (90.0%) of them being male. All patients exhibited the typical Type 1 BrS electrocardiogram pattern, and 16 (40.0%) were carriers of an SCN5A mutation. The Shanghai risk scores were comparable between the CA and the ICD groups (7.05 ± 0.80 vs. 6.71 ± 0.86, P = 0.351). Ventricular fibrillation-triggering PVCs were ablated in 3 patients (16.7%), while VF substrates were ablated in 15 patients (83.3%). Epicardial ablation was performed in 12 patients (66.7%). During a median follow-up of 46.2 (17.5-73.7) months, the primary outcomes occurred more frequently in the ICD group than in the CA group (5.6 vs. 54.5%, Log-rank P = 0.012).
Catheter ablation is an effective alternative therapy for improving arrhythmic outcomes in patients with symptomatic BrS who decline ICD implantation. Our findings support the consideration of CA as an alternative treatment option in this population.
摘要：
目的：本研究的目的是探讨在有症状的Brugada综合征（BrS）患者中，导管消融（CA）预防心律失常事件的效果，这些患者拒绝植入植入式心律转复除颤器（ICD）。
结果：共有40例有症状的BrS患者被纳入研究，其中18例患者拒绝ICD植入并接受CA,22例患者接受ICD植入。该研究采用了基质修饰（包括心内膜和心外膜入路）和VF触发室性早搏（PVC）消融策略。主要结果是复合终点，包括随访期间的心室纤颤（VF）发作和心源性猝死。研究人群的平均年龄为43.8±9.6岁，其中36人（90.0%）为男性。所有患者均表现为典型的1型BrS心电图，16例(40.0%)为SCN5A突变携带者。CA组和ICD组之间的上海风险评分具有可比性（7.05±0.80vs.6.71±0.86,P=0.351)。3例(16.7%)患者行VF触发性PVCs消融,15例患者(83.3%)消融VF基底。12例患者（66.7%）进行了心外膜消融。在46.2（17.5-73.7）个月的中位随访期间，与CA组相比，ICD组的主要结局发生频率更高(5.6%vs.54.5%,对数秩P=0.012)。
结论：CA是一种有效的替代疗法，可以改善有症状的BrS患者减少ICD植入的心律失常结局。我们的发现支持考虑将CA作为该人群的替代治疗方案。
结果：共有40例有症状的BrS患者被纳入研究，其中18例患者拒绝ICD植入并接受CA,22例患者接受ICD植入。该研究采用了基质修饰（包括心内膜和心外膜入路）和VF触发室性早搏（PVC）消融策略。主要结果是复合终点，包括随访期间的心室纤颤（VF）发作和心源性猝死。研究人群的平均年龄为43.8±9.6岁，其中36人（90.0%）为男性。所有患者均表现为典型的1型BrS心电图，16例(40.0%)为SCN5A突变携带者。CA组和ICD组之间的上海风险评分具有可比性（7.05±0.80vs.6.71±0.86,P=0.351)。3例(16.7%)患者行VF触发性PVCs消融,15例患者(83.3%)消融VF基底。12例患者（66.7%）进行了心外膜消融。在46.2（17.5-73.7）个月的中位随访期间，与CA组相比，ICD组的主要结局发生频率更高(5.6%vs.54.5%,对数秩P=0.012)。
结论：CA是一种有效的替代疗法，可以改善有症状的BrS患者减少ICD植入的心律失常结局。我们的发现支持考虑将CA作为该人群的替代治疗方案。
