Brugada Syndrome Ablation for the Prevention of Ventricular Fibrillation Episodes (BRAVE)
4
Issued Date
2025-01-01
Resource Type
ISSN
15475271
eISSN
15563871
Scopus ID
2-s2.0-105006616921
Pubmed ID
40294736
Journal Title
Heart Rhythm
Rights Holder(s)
SCOPUS
Bibliographic Citation
Heart Rhythm (2025)
Suggested Citation
Nademanee K., Wongcharoen W., Chimparlee N., Chokesuwattanaskul R., Annueypol M., Phusunti K., Sahasatas D., Prechawat S., Prasertwitayakij N., Makarawate P., Sutjaporn B., Wilde A., Drew C., Postema P.G., Ngarmukos T., Vardhanabhuti S., Veerakul G., Wandee P., Mauleekoonphairoj J., Poovorawan Y., Khongphatthanyaothin A. Brugada Syndrome Ablation for the Prevention of Ventricular Fibrillation Episodes (BRAVE). Heart Rhythm (2025). doi:10.1016/j.hrthm.2025.04.033 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/110727
Title
Brugada Syndrome Ablation for the Prevention of Ventricular Fibrillation Episodes (BRAVE)
Author(s)
Nademanee K.
Wongcharoen W.
Chimparlee N.
Chokesuwattanaskul R.
Annueypol M.
Phusunti K.
Sahasatas D.
Prechawat S.
Prasertwitayakij N.
Makarawate P.
Sutjaporn B.
Wilde A.
Drew C.
Postema P.G.
Ngarmukos T.
Vardhanabhuti S.
Veerakul G.
Wandee P.
Mauleekoonphairoj J.
Poovorawan Y.
Khongphatthanyaothin A.
Wongcharoen W.
Chimparlee N.
Chokesuwattanaskul R.
Annueypol M.
Phusunti K.
Sahasatas D.
Prechawat S.
Prasertwitayakij N.
Makarawate P.
Sutjaporn B.
Wilde A.
Drew C.
Postema P.G.
Ngarmukos T.
Vardhanabhuti S.
Veerakul G.
Wandee P.
Mauleekoonphairoj J.
Poovorawan Y.
Khongphatthanyaothin A.
Author's Affiliation
Faculty of Medicine, Khon Kaen University
Pacific Rim Electrophysiology Research Institute
Bangkok Heart Hospital
Maharaj Nakhon Ratchasima Hospital
Universiteit van Amsterdam
Bumrungrad International Hospital
Faculty of Medicine, Chulalongkorn University
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Amsterdam Cardiovascular Sciences
Faculty of Medicine, Chiang Mai University
Pacific Rim Electrophysiology Research Institute
Bangkok Heart Hospital
Maharaj Nakhon Ratchasima Hospital
Universiteit van Amsterdam
Bumrungrad International Hospital
Faculty of Medicine, Chulalongkorn University
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Amsterdam Cardiovascular Sciences
Faculty of Medicine, Chiang Mai University
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Catheter ablation has emerged as a promising treatment to prevent ventricular fibrillation (VF) in Brugada syndrome (BrS). However, evidence from a prospective, randomized clinical trial is lacking. Objective: The Brugada Syndrome Ablation for the Prevention of Ventricular Fibrillation Episodes trial is a prospective, multicenter, 2-arm, randomized (1:1), open-label clinical study designed to evaluate the efficacy and safety of ablation therapy in patients with symptomatic BrS. Methods: We enrolled patients with symptomatic BrS with an implantable cardioverter-defibrillator. Patients were randomized to ablation therapy or control groups. Ablation targeted arrhythmogenic areas identified through electroanatomical mapping, predominantly at the right ventricular epicardium. The primary outcome was the first occurrence of VF or death. One interim analysis was planned after 50 patients were randomized. Results: Of 67 patients screened, 52 were randomized (25 to ablation, 25 to control, 2 withdrawals), and 15 declined randomizations but remained in a registry (10 chose ablation, 5 opted against ablation). After 3 years of follow-up, the ablation group had significantly fewer VF events than the control group (hazard ratio, 0.288; P = .0184). At the interim analysis, the Data Safety Monitoring Board recommended early trial termination. Among all ablation recipients (including crossovers and registry participants), 83% remained VF free after a single procedure and 90% after a repeat ablation. Complications of ablation included 1 hemopericardium without a long-term sequel. Conclusion: Epicardial substrate ablation significantly reduces VF recurrence in patients with symptomatic BrS with implantable cardioverter-defibrillators and seems safe, supporting its potential role as a first-line therapy to prevent recurrent VF in patients with symptomatic BrS.