Future direction of substrate‐based catheter ablation in Brugada syndrome and other inherited primary arrhythmia syndromes: Systematic review and meta‐analysis

BACKGROUND: Inherited Primary Arrhythmias Syndromes (IPAS), especially Brugada syndrome (BrS), have been associated with arrhythmogenic substrates that can be targeted through ablation. This meta‐analysis evaluated the outcomes of catheter ablation (CA) in different types of IPAS based on procedural guidance and location. METHODS: A systematic search was conducted across multiple databases to identify studies reporting on ventricular arrhythmia (VA) events before and after CA in IPAS, including BrS, Long‐QT syndrome (LQTS), Early repolarization syndrome (ERS), and Idiopathic ventricular fibrillation (IVF). The primary outcomes were VA recurrence and VA burden, evaluated through conditional subgroup analysis. Procedural data were collected as secondary outcomes. RESULTS: A total of 21 studies involving 584 IPAS patients who underwent CA were included. Following a mean follow‐up duration of 33.5 months, substrate‐based ablation demonstrated efficacy in reducing VA recurrence across all types of IPAS [RR 0.23; 95% CI (0.13–0.39); p < .001; I (2) = 74%]. However, activation guidance ablation was found to be effective only in IVF cases. Although recurrences still occurred, CA was successful in reducing VA burden [MD –4.70; 95% CI (−6.11–(−3.29); p < .001; I (2) = 74%]. The mean size of arrhythmogenic substrate was 15.70 cm(2) [95% CI (12.34–19.99 cm(2))], predominantly distributed in the epicardial right ventricular outflow tract (RVOT) in BrS cases and LQTS [Proportion 0.99; 95% CI (0.96–1.00) and Proportion 0.82; 95% CI ( 0.59–1.00), respectively]. CONCLUSION: Substrate‐based CA has demonstrated effective prevention of VA and reduction in VA burden in IPAS cases.