This clinical trial aims to learn about the electrophysiological and clinical effects of radiofrequency catheter ablation in patients with Brugada syndrome. The main questions it seeks to answer are: * What are the immediate effects of catheter radiofrequency ablation in cardiac electrophysiology? * What is the relation between invasive and clinical features in patients with Brugada syndrome undergoing ablation? Researchers will compare ablation and control groups to see if there is a difference in clinical and invasive markers of the disease in one year of follow-up.
Brugada syndrome (BS) is an electric cardiac disorder characterized by a typical electrocardiographic pattern and an increased risk of cardiac arrhythmias and sudden death. Most arrhythmic events occur during rest, fever or under circumstances of increased vagal activity. In the last decade, catheter ablation has emerged as a valuable and potentially curative therapy for patients with BS. However, little is known about its mechanisms or long-term effects on clinical and invasive markers. This prospective, single-centre, randomized, sham-controlled, and masked pilot study will investigate the impact of catheter ablation in 20 patients with Brugada syndrome, who will be randomized to ablation or control group, with a 1:1 allocation ratio and clinically followed for 12 months.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
12
Radiofrequency application via catheter to burn the electroanatomic substrate implicated in Brugada syndrome
Venous and epicardial punctions, catheter insertions, programmed electrical stimulation and electroanatomical mapping
Instituto do Coração - InCor - HC/FMUSP
São Paulo, Brazil
RECRUITINGArea of abnormal potentials
Electroanatomic duration map
Time frame: first 30 minutes after the intervention
Induction of sustained ventricular arrhythmias by programmed electrical stimulation
Programmed electrical stimulation (PES) performed on two sites (right ventricular apex and right ventricular outflow tract, unless the patient had inducible ventricular tachycardia at the first location), with energy of twice the diastolic threshold, using two drive cycles (S1: 600 and 430 ms) up to 3 extra stimuli (S2 to S4) with 200 ms as the shortest coupling time. The PVS result is considered positive if sustained ventricular fibrillation or polymorphic ventricular tachycardia is induced.
Time frame: first 30 minutes after the intervention
Maximum potential duration
Maximum length of ventricular signs on bipolar electrogram
Time frame: first 30 minutes after the intervention
Local activation time
Measured by unipolar catheters placed in the epicardial and endocardial ventricular surfaces
Time frame: first 30 minutes after the intervention
Activation recovery interval
Surrogate marker of the action potential duration, measured by unipolar catheters placed in the epicardial and endocardial ventricular surfaces
Time frame: first 30 minutes after the intervention
Spontaneous type 1 Brugada electrocardiographic pattern in standard12 lead and superior leads electrocardiogram
Upward ST segment elevation ST-segment elevation ≥2 mm followed by a negative T wave (type 1 Brugada electrocardiographic pattern) in one or more right precordial leads V1 and/or V2 positioned in the second, third, or fourth intercostal spaces.
Time frame: up to one year after the procedure
Spontaneous type 1 Brugada electrocardiographic pattern in 12 lead 24 hour Holter monitoring
Upward ST segment elevation ST-segment elevation ≥2 mm followed by a negative T wave (type 1 Brugada electrocardiographic pattern) in one or more right precordial leads V1 and/or V2 positioned in the second, third, or fourth intercostal spaces during 12 lead 24h Holter ECG Monitoring
Time frame: up to one year after the procedure
Spontaneous type 1 Brugada electrocardiographic pattern during treadmill test
Upward ST segment elevation ST-segment elevation ≥2 mm followed by a negative T wave (type 1 Brugada electrocardiographic pattern) in one or more right precordial leads V1 and/or V2 positioned in the second, third, or fourth intercostal spaces, during treadmill test.
Time frame: up to one year after the procedure
Occurrence of life threatening arrhythmic events
Occurrence of at least one of the following: arrhythmic syncope, documented sustained ventricular tachycardia or ventricular fibrillation, sudden cardiac death or appropriate implantable cardiac defibrillator therapy
Time frame: up to one year after the procedure
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