Brugada syndrome: a review and the role of epicardial ablation in management

Abstract

Background: Brugada syndrome (BrS) is an inherited arrhythmogenic syndrome characterized by cove-shaped ST-segment elevation in leads V1–V3 and incomplete or complete right bundle branch block. BrS exhibits autosomal dominant inheritance with incomplete penetrance and a male predominance. It carries a significant risk of sudden cardiac death due to ventricular fibrillation (VF). Main body: Recent studies have highlighted the presence of epicardial fibrosis as a proarrhythmic substrate in BrS, revolutionizing our understanding of the disease's pathophysiology. Catheter ablation has emerged as a crucial intervention for symptomatic BrS patients experiencing recurrent episodes of ventricular tachycardia (VT) or VF. By potentially obviating the need for implantable cardioverter–defibrillator (ICD) implantation, epicardial ablation offers a promising therapeutic approach. Conclusion: This review emphasizes the significance of current evidence and ongoing research in shaping the role of epicardial ablation as a curative strategy in BrS management, highlighting its potential benefits and the necessity for further investigation.