Evaluating the safety and effectiveness of pulmonary vein isolation in Brugada syndrome patients with atrial fibrillation: a comprehensive systematic review and meta-analysis
A Askarinejad, P Firoozbakhsh, A Sabahizadeh, E Kohansal, A Pakmehr, G Lip, M HaghjooAbstract
Background
Brugada syndrome is an inherited arrhythmogenic disorder responsible for approximately 4% of sudden cardiac deaths. AF frequently coexists and increases the risk of inappropriate implantable cardioverter-defibrillator therapies. Antiarrhythmic drugs are often limited by proarrhythmic effects, creating an unmet therapeutic need.
Purpose
We evaluated whether pulmonary vein isolation safely reduces inappropriate defibrillator therapies and atrial fibrillation recurrence in patients with Brugada syndrome.
Methods
We conducted a systematic review and meta-analysis of studies published in PubMed, Embase, Web of Science, and Scopus from inception until 14 February 2026. We included studies reporting outcomes of PVI in patients with Brugada syndrome and AF. The primary endpoint was inappropriate implantable cardioverter-defibrillator shocks after ablation. Secondary endpoints included freedom from AF, recurrence rate, and baseline clinical characteristics. Pooled risk differences and proportions were calculated using random-effects models.
Results
A total of 2,149 studies were initially identified. After screening and eligibility assessment, five studies comprising 214 patients were included in the final analysis. The mean age of participants ranged from 45.8 ± 15.5 to 57 ± 10 years, and the proportion of male patients ranged from 33.3% to 100% across studies. PVI significantly reduced inappropriate defibrillator shocks (pooled risk difference −0.35). Freedom from AF was achieved in 82% of patients. The pooled recurrence rate was 36%. A spontaneous type 1 electrocardiographic pattern was present in 10% of patients, and 32% had a family history of sudden cardiac death. Procedural complications were uncommon across studies.
Conclusion(s)
PVI reduces inappropriate defibrillator therapies and provides effective rhythm control in patients with Brugada syndrome and AF. The procedure demonstrates favourable safety and acceptable recurrence rates. These findings support catheter ablation as a valuable treatment strategy in this high-risk population and justify further prospective investigationFigure 1