Brugada syndrome is probably the most fascinating discovery in Inherited cardiac Ion channel dysfunction that linked the basic sciences to bedside . Its due to genetic defect in SCN gene that results in sodium channel blockade of phase of action potential to cause troublesome ventricular tachycardia (Phase 2 reentry ) . Now we realise, there are some phenotypic expressions to this gene defect . RV epicardial anatomical substrates are found to responsible for these Arrhythmias.
So ,does Brugada turn out to be a structural heart disease (At least histological ) ? Where is the evidence coming from ?
Now, we realise RF ablation of epicardial aspect of RVOT / Adjacent anterior RV wall can eliminate Brugada pattern confirming anatomical defect at cellular level. Our changing perception of Brugada from pure functional to anatomical cause is exciting and intriguing as well ! ICDs were the specific therapy so far.This discovery make it RF ablation an option.
The recent data from Brugada himself was presented in World congress of electrophysiology / European Heart Rhythm Association (EHRA) EUROPACE-CARDIOSTIM 2016 confirming the therapeutic benefit of targeting the epicardial structural phenotypic substrares (Ref 3 )
We have been taught Brugada syndrome is a primary electrical disease .It was never considered as structural heart disease. Knowledge evolves slowly, so we shouldn’t conclude prematurely .Shall we conclude , Brugada syndrome is truly a structural heart disease at least in some ?*. This makes RF ablation a new cure for Brugada , making it a useful alternate modality to ICD , Of course there can be an overlap between ARVD and Brugada syndrome. Mind you RF ablation scores over ICD on any given day as its potential cure , while ICD is just a back up device and it simply wait & watch for the VT to occur.We also know ICDs are still learning human EP data, and are not intelligent enough to differentiate true VT from false ones with acceptable error** margin.
* Let the experts decide
**Acceptable ? What do you mean by that ?
2.Nademanee K1, Veerakul G, Chandanamattha P, Prevention of ventricular fibrillation episodes in Brugada syndrome by catheter ablation over the anterior right ventricular outflow tract epicardium.Circulation. 2011 Mar 29;123(12):1270-9.
3.Pappone C, Brugada J, Vicedomini G, et al. Epicardial ablation in Brugada syndrome. Insights from a prospective registry study of 50 consecutive patients. European Heart Rhythm Association EUROPACE-CARDIOSTIM 2016; June 8, 2016; Nice, France.
2.Is Amiodarone Indicated in Brugada syndrome ?