Long-Term Outcomes of Brugada Substrate Ablation: A Report from BRAVO (Brugada Ablation of VF Substrate Ongoing Multicenter Registry)

• Published in: Circulation (New York, N.Y.) N.Y.), 2023-05, Vol.147 (21), p.1568-1578
• Main Authors: Nademanee, Koonlawee, Chung, Fa-Po, Sacher, Frederic, Nogami, Akihiko, Nakagawa, Hiroshi, Jiang, Chenyang, Hocini, Meleze, Behr, Elijah, Veerakul, Gumpanart, Jan Smit, Jaap, Wilde, Arthur A.M., Chen, Shih-Ann, Yamashiro, Kohei, Sakamoto, Yuichiro, Morishima, Itsuro, Das, Mithilesh K., Khongphatthanayothin, Apichai, Vardhanabhuti, Saran, Haissaguerre, Michel
• Format: Article
• Language: English
• Subjects: Adult; Brugada Syndrome - complications; Brugada Syndrome - surgery; Catheter Ablation - adverse effects; Catheter Ablation - methods; Defibrillators, Implantable - adverse effects; Electrocardiography - methods; Heart Ventricles; Humans; Male; Registries; Ventricular Fibrillation
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.122.063367

Treatment options for high-risk Brugada syndrome (BrS) with recurrent ventricular fibrillation (VF) are limited. Catheter ablation is increasingly performed but a large study with long-term outcome data is lacking. We report the results of the multicenter, international BRAVO (Brugada Ablation of VF Substrate Ongoing Registry) for treatment of high-risk symptomatic BrS. We enrolled 159 patients (median age 42 years; 156 male) with BrS and spontaneous VF in BRAVO; 43 (27%) of them had BrS and early repolarization pattern. All but 5 had an implantable cardioverter-defibrillator for cardiac arrest (n=125) or syncope (n=34). A total of 140 (88%) had experienced numerous implantable cardioverter-defibrillator shocks for spontaneous VF before ablation. All patients underwent a percutaneous epicardial substrate ablation with electroanatomical mapping except for 8 who underwent open-thoracotomy ablation. In all patients, VF/BrS substrates were recorded in the epicardial surface of the right ventricular outflow tract; 45 (29%) patients also had an arrhythmic substrate in the inferior right ventricular epicardium and 3 in the posterior left ventricular epicardium. After a single ablation procedure, 128 of 159 (81%) patients remained free of VF recurrence; this number increased to 153 (96%) after a repeated procedure (mean 1.2±0.5 procedures; median=1), with a mean follow-up period of 48±29 months from the last ablation. VF burden and frequency of shocks decreased significantly from 1.1±2.1 per month before ablation to 0.003±0.14 per month after the last ablation (