Epicardial Substrate Ablation in Symptomatic Brugada Syndrome Patients: An Updated Systematic Review and Single-arm Meta-analysis.

Background: Brugada syndrome (BrS) is a genetic heart disease that predisposes individuals to ventricular arrhythmias and sudden cardiac death. Although implantable cardioverter-defibrillators (ICDs) and quinidine are primary treatments, recurrent BrS-triggered ventricular arrhythmias can persist. In this setting, epicardial substrate ablation has emerged as a promising alternative for symptomatic patients.

Objective: Evaluate the effectiveness and safety of epicardial substrate ablation in patients with BrS.

Methods: In this single-arm meta-analysis, we systematically searched PubMed, Embase, and Cochrane databases following PRISMA guidelines for studies including BrS patients with epicardial substrate ablation. Data was extracted, and statistical analysis was performed using random-effects modeling for proportional meta-analysis.

Results: 13 cohort studies comprising 555 BrS patients were included. The mean age at enrollment was 42.6 ± 12.3 years; 82.7% were males, and 50% exhibited spontaneous type 1 Brugada ECG pattern. Pooled analysis demonstrated resolution of the type 1 pattern in 91% of the cases (95% CI 80-98%; I=86%) and elimination of abnormal electrograms in 91% (95% CI 78-99%; I=74%). Rates of recurrent VT/VF and appropriate ICD therapies during post-ablation follow-up were 12% (95% CI 4-21%; I=86%) and 8% (95% CI 2-18%; I=87%), respectively.

Conclusions: Epicardial substrate ablation shows promise for BrS patients experiencing BrS-triggered ventricular arrhythmias, offering therapeutic efficacy with an acceptable safety profile. High heterogeneity among studies highlights the need for further research and standardized protocols.