• Takeshi Kitamura, Seiji Fukamizu, Iwanari Kawamura, Rintaro Hojo, Yuya Aoyama, Kota Komiyama, Mitsuhiro Nishizaki, Masayasu Hiraoka, and Harumizu Sakurada.
• Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan. Electronic address: take1124@hotmail.co.jp.
• Heart Rhythm. 2016 Jul 1; 13 (7): 1455-9.

BackgroundIn patients with an implantable cardioverter-defibrillator (ICD) and Brugada syndrome (BrS), the long-term efficacy of catheter ablation for preventing inappropriate shock therapy due to paroxysmal atrial fibrillation (PAF) has not been elucidated.ObjectiveTo evaluate the efficacy of atrial fibrillation (AF) ablation for PAF for prevention of inappropriate ICD therapy over a longer follow-up period.MethodsWe enrolled 76 men with BrS and an ICD, with a mean age of 46.2 ± 16.5 years. Twenty-one patients had AF (19 had PAF, 1 had persistent AF, and 1 had longstanding persistent AF). Fourteen patients with PAF underwent pulmonary vein isolation (PVI) and received follow-up electrophysiological study (EPS) 6 months after the first PVI. If necessary, ablation was performed.ResultsOver a mean follow-up period of 3.3 ± 1.4 years after the repeat session, 13 of the 14 patients (92.9%) had no recurrence of AF. Six patients with PAF without inappropriate ICD therapy before PVI had no recurrence of AF and no inappropriate therapy during follow-up. Among the 8 patients who had inappropriate therapy because of PAF before PVI, 1 patient who had recurrent AF underwent another ablation session. After this final session, there were no recurrences of AF and no inappropriate therapy (mean follow-up period 3.1± 1.2 years).ConclusionCatheter ablation is effective in patients with BrS and an ICD, and prevents inappropriate ICD therapy owing to PAF; thus, catheter ablation is an appropriate first-line therapy for PAF among such patients.Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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