Long-term efficacy of catheter ablation for paroxysmal atrial fibrillation in patients with Brugada syndrome and an implantable cardioverter-defibrillator to prevent inappropriate shock therapy

• Published in: Heart rhythm Vol. 13; no. 7; pp. 1455 - 1459
• Main Authors: Kitamura, Takeshi, MD, Fukamizu, Seiji, MD, Kawamura, Iwanari, MD, Hojo, Rintaro, MD, Aoyama, Yuya, MD, PhD, Komiyama, Kota, MD, Nishizaki, Mitsuhiro, MD, PhD, Hiraoka, Masayasu, MD, PhD, FHRS, Sakurada, Harumizu, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2016
• Subjects: Adult; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Fibrillation - etiology; Atrial Fibrillation - surgery; Brugada syndrome; Brugada Syndrome - diagnosis; Brugada Syndrome - epidemiology; Brugada Syndrome - therapy; Cardiovascular; Catheter ablation; Catheter Ablation - adverse effects; Catheter Ablation - methods; Defibrillators, Implantable; Electric Countershock - adverse effects; Electric Countershock - instrumentation; Electric Countershock - methods; Female; Follow-Up Studies; Humans; Implantable cardioverter-defibrillator; Japan - epidemiology; Long Term Adverse Effects - diagnosis; Long Term Adverse Effects - epidemiology; Long Term Adverse Effects - etiology; Male; Middle Aged; Paroxysmal atrial fibrillation; Pulmonary vein isolation; Pulmonary Veins - surgery; Treatment Outcome; Ventricular fibrillation; Brugada syndrome; Paroxysmal atrial fibrillation; Implantable cardioverter-defibrillator; Catheter ablation; Pulmonary vein isolation; Ventricular fibrillation
• ISSN: 1547-5271; 1556-3871
• DOI: 10.1016/j.hrthm.2016.03.006

Background In patients with an implantable cardioverter-defibrillator (ICD) and Brugada syndrome (BrS), the long-term efficacy of catheter ablation for preventing inappropriate shock therapy due to paroxysmal atrial fibrillation (PAF) has not been elucidated. Objective To evaluate the efficacy of atrial fibrillation (AF) ablation for PAF for prevention of inappropriate ICD therapy over a longer follow-up period. Methods We enrolled 76 men with BrS and an ICD, with a mean age of 46.2 ± 16.5 years. Twenty-one patients had AF (19 had PAF, 1 had persistent AF, and 1 had longstanding persistent AF). Fourteen patients with PAF underwent pulmonary vein isolation (PVI) and received follow-up electrophysiological study (EPS) 6 months after the first PVI. If necessary, ablation was performed. Results Over a mean follow-up period of 3.3 ± 1.4 years after the repeat session, 13 of the 14 patients (92.9%) had no recurrence of AF. Six patients with PAF without inappropriate ICD therapy before PVI had no recurrence of AF and no inappropriate therapy during follow-up. Among the 8 patients who had inappropriate therapy because of PAF before PVI, 1 patient who had recurrent AF underwent another ablation session. After this final session, there were no recurrences of AF and no inappropriate therapy (mean follow-up period 3.1± 1.2 years). Conclusion Catheter ablation is effective in patients with BrS and an ICD, and prevents inappropriate ICD therapy owing to PAF; thus, catheter ablation is an appropriate first-line therapy for PAF among such patients.