Long‐Term Outcomes of Pulmonary Vein Isolation in Patients With Brugada Syndrome and Paroxysmal Atrial Fibrillation
Background Pharmacological treatment of atrial fibrillation (AF) in the setting of Brugada syndrome (BrS) is challenging. In addition, patients with BrS with an implantable cardioverter‐defibrillator (ICD) might experience inappropriate shocks for fast AF. Long‐term outcome of pulmonary vein isolati...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-08-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.026290 |
| _version_ | 1827985931971330048 |
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| author | Antonio Bisignani Giulio Conte Luigi Pannone Juan Sieira Alvise Del Monte Felicia Lipartiti Gezim Bala Vincenzo Miraglia Cinzia Monaco Erwin Ströker Ingrid Overeinder Alexandre Almorad Anaïs Gauthey Livia Franchetti Pardo Matthias Raes Olivier Detriche Pedro Brugada Angelo Auricchio Gian‐Battista Chierchia Carlo de Asmundis |
| author_facet | Antonio Bisignani Giulio Conte Luigi Pannone Juan Sieira Alvise Del Monte Felicia Lipartiti Gezim Bala Vincenzo Miraglia Cinzia Monaco Erwin Ströker Ingrid Overeinder Alexandre Almorad Anaïs Gauthey Livia Franchetti Pardo Matthias Raes Olivier Detriche Pedro Brugada Angelo Auricchio Gian‐Battista Chierchia Carlo de Asmundis |
| author_sort | Antonio Bisignani |
| collection | DOAJ |
| description | Background Pharmacological treatment of atrial fibrillation (AF) in the setting of Brugada syndrome (BrS) is challenging. In addition, patients with BrS with an implantable cardioverter‐defibrillator (ICD) might experience inappropriate shocks for fast AF. Long‐term outcome of pulmonary vein isolation in BrS has not been well established yet, and it is still unclear whether pulmonary vein triggers are the only pathophysiological mechanism of AF in BrS. The aim of the study is to assess the long‐term outcomes in patients with BrS undergoing pulmonary vein isolation for paroxysmal AF compared with a matched cohort of patients without BrS. Methods and Results Sixty patients with BrS undergoing pulmonary vein isolation with cryoballoon catheter ablation for paroxysmal AF were matched with 60 patients without BrS, who underwent the same procedure. After a mean follow‐up of 58.2±31.7 months, freedom from atrial tachyarrhythmias was achieved in 61.7% in the BrS group and in 78.3% in the non‐BrS group (log‐rank P=0.047). In particular, freedom from AF was 76.7% in the first group and in 83.3% in the second (P=0.27), while freedom from atrial tachycardia/atrial flutter was 85% and 95% (P=0.057). In the BrS group, 29 patients (48.3%) had an ICD and 8 (27.6%) had a previous ICD‐inappropriate shock for fast AF. In the BrS cohort, ICD‐inappropriate interventions for AF were significantly reduced after ablation (3.4% versus 27.6%; P=0.01). Conclusions Pulmonary vein isolation in patients with BrS was associated with higher rate of arrhythmic recurrence. Despite this, catheter ablation significantly reduced inappropriate ICD interventions in BrS patients and can be considered a therapeutic strategy to prevent inappropriate device therapies. |
| first_indexed | 2024-04-09T23:23:52Z |
| format | Article |
| id | doaj.art-30b784e24a8f4373b17a83a6e672278c |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-09T23:23:52Z |
| publishDate | 2022-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-30b784e24a8f4373b17a83a6e672278c2023-03-21T11:37:26ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-08-01111510.1161/JAHA.122.026290Long‐Term Outcomes of Pulmonary Vein Isolation in Patients With Brugada Syndrome and Paroxysmal Atrial FibrillationAntonio Bisignani0Giulio Conte1Luigi Pannone2Juan Sieira3Alvise Del Monte4Felicia Lipartiti5Gezim Bala6Vincenzo Miraglia7Cinzia Monaco8Erwin Ströker9Ingrid Overeinder10Alexandre Almorad11Anaïs Gauthey12Livia Franchetti Pardo13Matthias Raes14Olivier Detriche15Pedro Brugada16Angelo Auricchio17Gian‐Battista Chierchia18Carlo de Asmundis19Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard‐Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels BelgiumDivision of Cardiology Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale Lugano SwitzerlandPostgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard‐Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels BelgiumPostgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard‐Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels BelgiumPostgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard‐Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels BelgiumPostgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard‐Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels BelgiumPostgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard‐Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels BelgiumPostgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard‐Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels BelgiumPostgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard‐Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels BelgiumPostgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard‐Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels BelgiumPostgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard‐Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels BelgiumPostgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard‐Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels BelgiumPostgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard‐Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels BelgiumDivision of Cardiology Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale Lugano SwitzerlandAnaesthesiology Department Vrije Universiteit Brussel Brussels BelgiumAnaesthesiology Department Vrije Universiteit Brussel Brussels BelgiumPostgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard‐Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels BelgiumDivision of Cardiology Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale Lugano SwitzerlandPostgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard‐Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels BelgiumPostgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard‐Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels BelgiumBackground Pharmacological treatment of atrial fibrillation (AF) in the setting of Brugada syndrome (BrS) is challenging. In addition, patients with BrS with an implantable cardioverter‐defibrillator (ICD) might experience inappropriate shocks for fast AF. Long‐term outcome of pulmonary vein isolation in BrS has not been well established yet, and it is still unclear whether pulmonary vein triggers are the only pathophysiological mechanism of AF in BrS. The aim of the study is to assess the long‐term outcomes in patients with BrS undergoing pulmonary vein isolation for paroxysmal AF compared with a matched cohort of patients without BrS. Methods and Results Sixty patients with BrS undergoing pulmonary vein isolation with cryoballoon catheter ablation for paroxysmal AF were matched with 60 patients without BrS, who underwent the same procedure. After a mean follow‐up of 58.2±31.7 months, freedom from atrial tachyarrhythmias was achieved in 61.7% in the BrS group and in 78.3% in the non‐BrS group (log‐rank P=0.047). In particular, freedom from AF was 76.7% in the first group and in 83.3% in the second (P=0.27), while freedom from atrial tachycardia/atrial flutter was 85% and 95% (P=0.057). In the BrS group, 29 patients (48.3%) had an ICD and 8 (27.6%) had a previous ICD‐inappropriate shock for fast AF. In the BrS cohort, ICD‐inappropriate interventions for AF were significantly reduced after ablation (3.4% versus 27.6%; P=0.01). Conclusions Pulmonary vein isolation in patients with BrS was associated with higher rate of arrhythmic recurrence. Despite this, catheter ablation significantly reduced inappropriate ICD interventions in BrS patients and can be considered a therapeutic strategy to prevent inappropriate device therapies.https://www.ahajournals.org/doi/10.1161/JAHA.122.026290atrial fibrillationBrugada syndromecryoballooninappropriate shockpulmonary vein isolation |
| spellingShingle | Antonio Bisignani Giulio Conte Luigi Pannone Juan Sieira Alvise Del Monte Felicia Lipartiti Gezim Bala Vincenzo Miraglia Cinzia Monaco Erwin Ströker Ingrid Overeinder Alexandre Almorad Anaïs Gauthey Livia Franchetti Pardo Matthias Raes Olivier Detriche Pedro Brugada Angelo Auricchio Gian‐Battista Chierchia Carlo de Asmundis Long‐Term Outcomes of Pulmonary Vein Isolation in Patients With Brugada Syndrome and Paroxysmal Atrial Fibrillation Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial fibrillation Brugada syndrome cryoballoon inappropriate shock pulmonary vein isolation |
| title | Long‐Term Outcomes of Pulmonary Vein Isolation in Patients With Brugada Syndrome and Paroxysmal Atrial Fibrillation |
| title_full | Long‐Term Outcomes of Pulmonary Vein Isolation in Patients With Brugada Syndrome and Paroxysmal Atrial Fibrillation |
| title_fullStr | Long‐Term Outcomes of Pulmonary Vein Isolation in Patients With Brugada Syndrome and Paroxysmal Atrial Fibrillation |
| title_full_unstemmed | Long‐Term Outcomes of Pulmonary Vein Isolation in Patients With Brugada Syndrome and Paroxysmal Atrial Fibrillation |
| title_short | Long‐Term Outcomes of Pulmonary Vein Isolation in Patients With Brugada Syndrome and Paroxysmal Atrial Fibrillation |
| title_sort | long term outcomes of pulmonary vein isolation in patients with brugada syndrome and paroxysmal atrial fibrillation |
| topic | atrial fibrillation Brugada syndrome cryoballoon inappropriate shock pulmonary vein isolation |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.026290 |
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