Brugada Syndrome Ablation for the Prevention of Ventricular Fibrillation Episodes (BRAVE)

Koonlawee Nademanee; Wanwarang Wongcharoen; Nitinan Chimparlee; Ronpichai Chokesuwattanaskul; Montawatt Annueypol; Keerapa Phusunti; Dujdao Sahasatas; Somchai Prechawat; Narawudt Prasertwitayakij; Pattarapong Makarawate; Boosamas Sutjaporn; Arthur Wilde; Carla Drew; Pieter G Postema; Tachapong Ngarmukos; Saran Vardhanabhuti; Gumpanart Veerakul; Pharawee Wandee; John Mauleekoonphairoj; Yong Poovorawan; Apichai Khongphatthanyaothin

doi:10.1016/j.hrthm.2025.04.033

Brugada Syndrome Ablation for the Prevention of Ventricular Fibrillation Episodes (BRAVE)

Heart Rhythm. 2025 Apr 26:S1547-5271(25)02381-1. doi: 10.1016/j.hrthm.2025.04.033. Online ahead of print.

Authors

Koonlawee Nademanee¹, Wanwarang Wongcharoen², Nitinan Chimparlee³, Ronpichai Chokesuwattanaskul³, Montawatt Annueypol⁴, Keerapa Phusunti⁵, Dujdao Sahasatas⁶, Somchai Prechawat³, Narawudt Prasertwitayakij², Pattarapong Makarawate⁶, Boosamas Sutjaporn³, Arthur Wilde⁷, Carla Drew⁸, Pieter G Postema⁷, Tachapong Ngarmukos⁴, Saran Vardhanabhuti⁸, Gumpanart Veerakul⁹, Pharawee Wandee³, John Mauleekoonphairoj³, Yong Poovorawan¹⁰, Apichai Khongphatthanyaothin³

Affiliations

¹ Center of Excellence in Arrhythmia Research Chulalongkorn University, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Heart Institute, Bumrungrad Hospital, Bangkok, Thailand; Pacific Rim Electrophysiology Research Institute, Las Vegas, Nevada. Electronic address: wee@pacificrimep.com.
² Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
³ Center of Excellence in Arrhythmia Research Chulalongkorn University, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁴ Department of Medicine, Faculty of Medicine at Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
⁵ Department of Medicine, Maharat Nakhon Ratchasima Hospital, Nakorn Ratchasima, Thailand.
⁶ Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
⁷ Department of Cardiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
⁸ Pacific Rim Electrophysiology Research Institute, Las Vegas, Nevada.
⁹ Bangkok Heart Hospital, Bangkok General Hospital, Bangkok, Thailand.
¹⁰ Center of Excellence in Arrhythmia Research Chulalongkorn University, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

PMID: 40294736
DOI: 10.1016/j.hrthm.2025.04.033

Abstract

Background: Catheter ablation has emerged as a promising treatment to prevent ventricular fibrillation (VF) in Brugada syndrome (BrS). However, evidence from a prospective, randomized clinical trial is lacking.

Objective: The Brugada Syndrome Ablation for the Prevention of Ventricular Fibrillation Episodes trial is a prospective, multicenter, 2-arm, randomized (1:1), open-label clinical study designed to evaluate the efficacy and safety of ablation therapy in patients with symptomatic BrS.

Methods: We enrolled patients with symptomatic BrS with an implantable cardioverter-defibrillator. Patients were randomized to ablation therapy or control groups. Ablation targeted arrhythmogenic areas identified through electroanatomical mapping, predominantly at the right ventricular epicardium. The primary outcome was the first occurrence of VF or death. One interim analysis was planned after 50 patients were randomized.

Results: Of 67 patients screened, 52 were randomized (25 to ablation, 25 to control, 2 withdrawals), and 15 declined randomizations but remained in a registry (10 chose ablation, 5 opted against ablation). After 3 years of follow-up, the ablation group had significantly fewer VF events than the control group (hazard ratio, 0.288; P = .0184). At the interim analysis, the Data Safety Monitoring Board recommended early trial termination. Among all ablation recipients (including crossovers and registry participants), 83% remained VF free after a single procedure and 90% after a repeat ablation. Complications of ablation included 1 hemopericardium without a long-term sequel.

Conclusion: Epicardial substrate ablation significantly reduces VF recurrence in patients with symptomatic BrS with implantable cardioverter-defibrillators and seems safe, supporting its potential role as a first-line therapy to prevent recurrent VF in patients with symptomatic BrS.

Keywords: Ablation; Brugada syndrome; Implantable cardioverter-defibrillator; Sudden death; Ventricular fibrillation.