Outcomes of catheter ablation in high-risk patients with Brugada syndrome refusing an ICD implantation

Abstract Aims 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. Methods and results A total of 40 patients with symptomatic BrS were included in the study, of which 18 patients refused ICD implantation and underwent CA, while 22 patients received ICD implantation. The study employed substrate modification (including endocardial and epicardial approaches) and VF-triggering premature ventricular contraction (PVC) ablation strategies. The primary outcomes were a composite endpoint consisting of episodes of ventricular fibrillation (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 ICD groups (7.05 ± 0.80 vs. 6.71 ± 0.86, P = 0.351). VF-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 compared to the CA group (5.6% vs. 54.5%, Log-rank P = 0.012). Conclusion CA 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.