Radiofrequency Ablation of Asymptomatic Brugada Syndrome: Don't Go Burning My Heart.

Abstract

Terror-Mori-Ex-Abrupto is the Latin term for fear of dropping dead. Based on frequent email consultations I receive from patients with suspected Brugada syndrome (BrS), it seems that a terrifying anticipation of dying is more dominant among asymptomatic patients with BrS than in other arrhythmogenic diseases. The tragic death of a young British man that went viral over Facebook, led >10,000 British citizens to petition their Parliament, requesting that all patients with asymptomatic BrS be given the choice of an implantable defibrillator (ICD) even in the absence of markers indicating increased risk . Already, 1 in 2 patients undergoing ICD implantation for BrS are asymptomatic and 1 in 5 are not only free of symptoms, but do not even have the Brugada electrocardiogram (ECG) spontaneously. 1, 2 Given that fatal arrhythmias are particularly rare among the last category of patients (see below), it is obvious that many patients and physicians are willing to do whatever it takes - instead of whatever is best - to avoid the rare occurrence of cardiac arrest, even if this involves some potentially serious complications related to ICD implantation. It is therefore not surprising that an increasing number of asymptomatic patients are opting to undergo a radiofrequency (RF) ablation procedure with the hope of curing their disease.