A new study confirms the effectiveness of arrhythmic substrate ablation as the best strategy. A screening is being studied to intercept unaware patients
Italian doctors at the San Donato Polyclinic in Milan have developed a therapeutic strategy which opens up important scenarios on the treatment of Brugada syndrome, genetic disease which causes a increased risk of malignant ventricular arrhythmias e Of
ventricular fibrillation
with concrete possibilities of save those who suffer from sudden death. A new study led by professor Carlo Papponedirector of the Electrophysiology and Arrhythmology operational unit of the Irccs Policlinico San Donato, published on Europace EPofficial magazine of the European Heart Rhythm Association (Ehra), has in fact confirmed the effectiveness ofablation of the arrhythmic substrate as the best therapeutic strategy against potentially fatal genetic heart disease.
What is Brugada syndrome
Brugada syndrome a rare hereditary disease, present since birth on the epicardial surface of the right ventricle. The disease is classified as bradyarrhythmia, i.e. arrhythmias characterized by a disturbance in the formation or conduction of the heart's electrical impulse, which arise mainly during sleep. Arrhythmias can begin at any ageeven if they occur more frequently, between 25-45 years. Brugada syndrome is estimated to be responsible for at least 4% of all sudden deaths and among these of at least 20% of deaths of patients with apparently structurally normal hearts. Those who suffer from Brugada syndrome very often have a Heart
apparently healthy and the condition can remain asymptomatic for life. Often the electrocardiogram alone is not sufficient to identify patients at risk: frequently the first symptom may be death itself And, in approximately 2/3 of cases, the electrocardiogram is completely normal.
The new study: ablation to eliminate abnormal electrical signals
The published study confirms the role of the extension of the arrhythmogenic substrate of Brugada Syndrome, the group of abnormal cells on the (epicardial) surface of the heart, at the level of the right ventricle, as a crucial prognostic factor for recurrent ventricular fibrillation events and validates the safety and effectiveness of epicardial radiofrequency ablation in eliminating all abnormal electrical signals located in the epicardium. Italian scientists already discovered in 2015 the so-called arrhythmic substrate, a group of cells that express anomalous electrical potentials, constituting an area that is associated with the clinical presentation of the disease and the risk of suffering from a more aggressive form of disease. , that associated with the development of malignant ventricular arrhythmias with a fatal risk.
How the work was done
In the long-term prospective investigative study, 257 selected patients with symptomatic Brugada syndrome with defibrillator implantation were included. Of these, 206 underwent epicardial radiofrequency ablation and were monitored for more than 5 years post-ablation. While a second group of 51 patients only received the implantation of a defibrillator. In the radiofrequency ablation group, substrates of Brugada syndrome were identified on the epicardial surface of the right ventricle. During the pre-ablation follow-up period, episodes of fibrillation were recorded in 53 patients. In the post-ablation follow-up period (median 40 months), the ablation group demonstrated superior results compared to the control group and without relevant complications related to the procedure.
A screening of the general population is being studied
The identification of the mechanisms of the pathology confirms the ablation of the arrhythmic substrate of Brugada syndrome as a strategy capable of effectively treating it. This result lays the foundation for further ones non-invasive methods to free patients from a disease that can threaten their lives every day, the researchers write in a note. It cannot be ruled out, in the near future, that this therapeutic technique could represent a valid alternative to implanting a defibrillator, which would make young patients limited in their daily life, both sporting and social. The same researchers announce the imminent publication of the results of a randomized study which demonstrates that this technique unequivocally saves patients who would otherwise be destined to die suddenly if suffering from a severe form of the disease. The same group is working on one screening of the general population to early identify patients unaware of being affected by Brugada syndrome.
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February 7, 2024 (changed February 7, 2024 | 3:03 pm)
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