Takeshi Kitamura1, Seiji Fukamizu2, Iwanari Kawamura2, Rintaro Hojo2, Yuya Aoyama2, Kota Komiyama2, Mitsuhiro Nishizaki3, Masayasu Hiraoka4, Harumizu Sakurada5. 1. Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan. Electronic address: take1124@hotmail.co.jp. 2. Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan. 3. Department of Cardiology, Yokohama Minami Kyosai Hospital, Yokohama, Japan. 4. Tokyo Medical and Dental University, Tokyo, Japan; Toride Kitasoma Medical Center Hospital, Ibaraki, Japan. 5. Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital, Tokyo, Japan.
Abstract
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.
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.