Adji Arga Setyo, Billah Atiyatum, Sit Juliardi Eka Putra, de Liyis Bryan Gervais, Nugraha Angga, Puspita Angela, Satrioaji Abdillah Maulana, Rosyadi Ragil Nur
Faculty of Medicine Hang Tuah University Surabaya East Java Indonesia.
Faculty of Medicine Udayana University Denpasar Bali Indonesia.
J Arrhythm. 2025 May 8;41(3):e70073. doi: 10.1002/joa3.70073. eCollection 2025 Jun.
Brugada syndrome (BrS) is a rare cardiac channelopathy linked to an increased risk of ventricular arrhythmias (VA) and sudden cardiac death. Radiofrequency ablation (RFA), particularly epicardial ablation, is recommended for BrS patients with recurrent VA unresponsive to conventional treatments like implantable cardioverter-defibrillators (ICD) and quinidine. This study aims to evaluate the long-term efficacy of epicardial RFA in preventing VA recurrence in BrS.
A systematic search of PubMed, ScienceDirect, Cochrane Library, and ProQuest databases was conducted following PRISMA 2020 guidelines. Studies on RFA for VA in BrS were included. Primary outcomes were VA recurrence and all-cause mortality. Statistical analysis was performed using Review Manager 5.4.
Epicardial, endocardial, and combined ablation strategies effectively reduced VA recurrence, decreased ICD shocks, and improved clinical outcomes in BrS. Epicardial ablation RFA near coronary arteries showed a notable reduction in VA recurrence, while endocardial ablation remained a viable alternative. Meta-analysis revealed a significant reduction in VA recurrence (RR 0.17; 95% CI 0.07-0.43; < .0001) and ICD shocks (RR 0.13; 95% CI 0.04-0.44; = .001). Subgroup analysis suggested greater VA reduction with epicardial ablation, though without statistical significance.
Epicardial RFA is associated with a significant reduction in recurrent VAs (83%) and ICD shock rates (87%) in patients with BrS. The procedure demonstrates a favorable long-term safety profile, with no mortality reported in the included studies.
布加综合征（BrS）是一种罕见的心脏离子通道病，与室性心律失常（VA）风险增加及心源性猝死相关。对于植入式心律转复除颤器（ICD）和奎尼丁等传统治疗无效的复发性VA的BrS患者，推荐进行射频消融（RFA），尤其是心外膜消融。本研究旨在评估心外膜RFA预防BrS患者VA复发的长期疗效。
按照PRISMA 2020指南对PubMed、ScienceDirect、Cochrane图书馆和ProQuest数据库进行系统检索。纳入关于BrS患者VA的RFA研究。主要结局为VA复发和全因死亡率。使用Review Manager 5.4进行统计分析。
心外膜、心内膜及联合消融策略均能有效降低BrS患者的VA复发，减少ICD电击次数，并改善临床结局。冠状动脉附近的心外膜消融RFA显示VA复发显著降低，而心内膜消融仍是可行的替代方法。荟萃分析显示VA复发（RR 0.17；95% CI 0.07 - 0.43；P <.0001）和ICD电击次数（RR 0.13；95% CI 0.04 - 0.44；P =.001）显著减少。亚组分析提示心外膜消融降低VA的效果更佳，尽管无统计学意义。
心外膜RFA与BrS患者复发性VA显著降低（83%）和ICD电击率显著降低（87%）相关。该手术显示出良好的长期安全性，纳入研究中未报告死亡病例。
