When to ablate in Brugada and early repolarization syndromes

ABSTRACT

Introduction

Mapping advances have expanded both the feasibility and benefits of ablation as a therapeutic approach, including in the treatment of two heart conditions that contribute to sudden cardiac death in young people: Brugada syndrome (BrS) and early repolarization syndrome (ERS). Although these conditions share a number of similarities, debates persist regarding the underlying pathophysiology and origin of the ventricular arrhythmias associated with them.

Areas covered

By synthesizing available data (PubMed), including current recommendations, pathophysiological insights and case reports, patient registries, our aim is to elucidate and establish the nuanced role of radiofrequency ablation (RFA) in therapeutic management.

Expert opinion

RFA is a particularly promising approach in BrS, with a proven long-term benefit. Concerning ERS, RFA seems to be interesting at the price of more complex procedures with more nuanced results.

KEYWORDS:

• Brugada syndrome
• early repolarization syndrome
• radiofrequency ablation
• early repolarization pattern
• ventricular fibrillation
• ventricular tachycardia

Article highlights

• Brugada Syndrome and Early Repolarization Syndrome share a number of pathophysiological mechanisms that explain their risk of ventricular arrhythmias.

• Preventing recurrence of ventricular arrhythmias in challenging, with few of effective management measures aside from resorting to defibrillator implantation as a preventive measure against sudden death.

• Improved mapping techniques have led to the development of radiofrequency ablation in BrS and ERS.

• RFA is a promising therapeutic approach, particularly in Brugada syndrome where drug treatments remain limited and ineffective.

Abbreviations

BrS	=	Brugada syndrome
ERP	=	Early Repolarization Pattern
ERS	=	Early Repolarization Syndrome
ICD	=	Implantable Cardioverter Defibrillator
ECG	=	Electrocardiogram
VT	=	Ventricular Tachycardia
VF	=	Ventricular Fibrillation
RV	=	Right Ventricle
AP	=	Action Potential
PVC	=	Premature Ventricular Contractions
RVOT	=	Right Ventricular Outflow Tract
RFA	=	Radiofrequency Ablation
LV	=	Left Ventricle
PES	=	Programed Electrical Stimulation

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.