{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T15:45:27Z","timestamp":1784735127600,"version":"3.55.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,1,22]],"date-time":"2024-01-22T00:00:00Z","timestamp":1705881600000},"content-version":"vor","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>This study aims to evaluate the prognostic impact of the arrhythmogenic substrate size in symptomatic Brugada syndrome (BrS) as well as to validate the long-term safety and effectiveness of epicardial radiofrequency ablation (RFA) compared with no-RFA group.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>In this prospective investigational long-term registry study, 257 selected symptomatic BrS patients with implantable cardioverter defibrillator (ICD) implantation were included. Among them, 206 patients underwent epicardial RFA and were monitored for over 5 years post-ablation (RFA group), while 51 patients received only ICD implantation declining RFA. Primary endpoints included risk factors for ventricular fibrillation (VF) events pre-ablation and freedom from VF events post-ablation. In the RFA group, BrS substrates were identified in the epicardial surface of the right ventricle. During the pre-RFA follow-up period (median 27 months), VF episodes and VF storms were experienced by 53 patients. Independent risk factors included substrate size [hazard ratio (HR), 1.13; 95% confidence interval (CI), 1.08\u20131.18; P &amp;lt; 0.001], aborted cardiac arrest (HR, 2.98; 95% CI, 1.68\u20135.28; P &amp;lt; 0.001), and SCN5A variants (HR, 2.22; 95% CI, 1.15\u20134.27; P = 0.017). In the post-RFA follow-up (median 40 months), the RFA group demonstrated superior outcomes compared with no-RFA (P &amp;lt; 0.001) without major procedure-related complications.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Our study underscores the role of BrS substrate extent as a crucial prognostic factor for recurrent VF and validates the safety and efficacy of RFA when compared with a no-RFA group. Our findings highlight the importance of ajmaline in guiding epicardial mapping\/ablation in symptomatic BrS patients, laying the groundwork for further exploration of non-invasive methods to guide informed clinical decision-making.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/europace\/euae019","type":"journal-article","created":{"date-parts":[[2024,1,22]],"date-time":"2024-01-22T21:51:55Z","timestamp":1705960315000},"source":"Crossref","is-referenced-by-count":21,"title":["High-risk Brugada syndrome: factors associated with arrhythmia recurrence and benefits of epicardial ablation in addition to implantable cardioverter defibrillator implantation"],"prefix":"10.1093","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5865-0311","authenticated-orcid":false,"given":"Vincenzo","family":"Santinelli","sequence":"first","affiliation":[{"name":"Arrhythmology Department, IRCCS Policlinico San Donato , Piazza E Malan, 20097 San Donato Milanese , 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Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4488-0455","authenticated-orcid":false,"given":"Emanuela T","family":"Locati","sequence":"additional","affiliation":[{"name":"Arrhythmology Department, IRCCS Policlinico San Donato , Piazza E Malan, 20097 San Donato Milanese , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3406-2675","authenticated-orcid":false,"given":"Antonio","family":"Boccellino","sequence":"additional","affiliation":[{"name":"Arrhythmology Department, IRCCS Policlinico San Donato , Piazza E Malan, 20097 San Donato Milanese , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1531-3504","authenticated-orcid":false,"given":"Gabriele","family":"Negro","sequence":"additional","affiliation":[{"name":"Arrhythmology Department, IRCCS Policlinico San Donato , Piazza E Malan, 20097 San Donato Milanese , 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