Vanessa Karlinski Vizentin, Iuri Ferreira Felix, Rafaela Pivato da Fonseca, Michelle Bozko Collini, Marcelo Antonio Pinheiro Braga, Caroline Serafim Dagostin, Luciana Vidal Armaganijan, Michael J Ackerman, Alexandra Régia Dantas Brígido, Guilherme Dagostin de Carvalho
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引用次数: 0
摘要
背景：布鲁加达综合征（Brugada syndrome，BRS）是一种遗传性心脏病，易导致室性心律失常和心脏性猝死。虽然植入式心律转复除颤器（ICD）和奎尼丁是主要的治疗方法，但布鲁格达综合征触发的室性心律失常仍会反复发作。在这种情况下，心外膜基质消融术已成为有症状患者的一种有前途的替代治疗方法：评估心外膜基底消融术对 BrS 患者的有效性和安全性：在这项单臂荟萃分析中，我们按照 PRISMA 指南系统检索了 PubMed、Embase 和 Cochrane 数据库中包括 BrS 患者心外膜基底消融术的研究。我们提取了数据，并使用比例荟萃分析的随机效应模型进行了统计分析：结果：共纳入 13 项队列研究，包括 555 名 BrS 患者。入选时的平均年龄为（42.6 ± 12.3）岁；82.7%为男性，50%表现为自发性1型Brugada心电图模式。汇总分析显示，91%的病例（95% CI 80-98%；I2=86%）的1型模式得到缓解，91%的病例（95% CI 78-99%；I2=74%）消除了异常电图。消融术后随访期间，VT/VF 复发率和适当的 ICD 治疗率分别为 12% (95% CI 4-21%; I2=86%) 和 8% (95% CI 2-18%; I2=87%)：结论：心外膜基底消融术有望治疗由 BrS 触发的室性心律失常患者，具有治疗效果和可接受的安全性。不同研究之间的高度异质性凸显了进一步研究和标准化方案的必要性。
Epicardial Substrate Ablation in Symptomatic Brugada Syndrome Patients: An Updated Systematic Review and Single-arm Meta-analysis.
Background: Brugada syndrome (BrS) is a genetic heart disease that predisposes individuals to ventricular arrhythmias and sudden cardiac death. Although implantable cardioverter-defibrillators (ICDs) and quinidine are primary treatments, recurrent BrS-triggered ventricular arrhythmias can persist. In this setting, epicardial substrate ablation has emerged as a promising alternative for symptomatic patients.
Objective: Evaluate the effectiveness and safety of epicardial substrate ablation in patients with BrS.
Methods: In this single-arm meta-analysis, we systematically searched PubMed, Embase, and Cochrane databases following PRISMA guidelines for studies including BrS patients with epicardial substrate ablation. Data was extracted, and statistical analysis was performed using random-effects modeling for proportional meta-analysis.
Results: 13 cohort studies comprising 555 BrS patients were included. The mean age at enrollment was 42.6 ± 12.3 years; 82.7% were males, and 50% exhibited spontaneous type 1 Brugada ECG pattern. Pooled analysis demonstrated resolution of the type 1 pattern in 91% of the cases (95% CI 80-98%; I2=86%) and elimination of abnormal electrograms in 91% (95% CI 78-99%; I2=74%). Rates of recurrent VT/VF and appropriate ICD therapies during post-ablation follow-up were 12% (95% CI 4-21%; I2=86%) and 8% (95% CI 2-18%; I2=87%), respectively.
Conclusions: Epicardial substrate ablation shows promise for BrS patients experiencing BrS-triggered ventricular arrhythmias, offering therapeutic efficacy with an acceptable safety profile. High heterogeneity among studies highlights the need for further research and standardized protocols.
期刊介绍：
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.
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