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

作者：Kitamura Takeshi^*; Fukamizu Seiji; Kawamura Iwanari; Hojo Rintaro; Aoyama Yuya; Komiyama Kota; Nishizaki Mitsuhiro; Hiraoka Masayasu; Sakurada Harumizu

来源：Heart Rhythm, 2016, 13(7): 1455-1459.

DOI：10.1016/j.hrthm.2016.03.006

• Brugada syndrome
• Paroxysmal atrial fibrillation
• Implantable cardioverter-defibrillator
• Catheter ablation
• Pulmonary vein isolation
• Ventricular fibrillation

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.

• 出版日期2016-7