{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T20:20:34Z","timestamp":1792268434482,"version":"4.4.0"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","license":[{"start":{"date-parts":[[2023,5,23]],"date-time":"2023-05-23T00:00:00Z","timestamp":1684800000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2023,5,23]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Treatment options for high-risk Brugada syndrome (BrS) with recurrent ventricular fibrillation (VF) are limited. Catheter ablation is increasingly performed but a large study with long-term outcome data is lacking. We report the results of the multicenter, international BRAVO (Brugada Ablation of VF Substrate Ongoing Registry) for treatment of high-risk symptomatic BrS.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>We enrolled 159 patients (median age 42 years; 156 male) with BrS and spontaneous VF in BRAVO; 43 (27%) of them had BrS and early repolarization pattern. All but 5 had an implantable cardioverter-defibrillator for cardiac arrest (n=125) or syncope (n=34). A total of 140 (88%) had experienced numerous implantable cardioverter-defibrillator shocks for spontaneous VF before ablation. All patients underwent a percutaneous epicardial substrate ablation with electroanatomical mapping except for 8 who underwent open-thoracotomy ablation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              In all patients, VF\/BrS substrates were recorded in the epicardial surface of the right ventricular outflow tract; 45 (29%) patients also had an arrhythmic substrate in the inferior right ventricular epicardium and 3 in the posterior left ventricular epicardium. After a single ablation procedure, 128 of 159 (81%) patients remained free of VF recurrence; this number increased to 153 (96%) after a repeated procedure (mean 1.2\u00b10.5 procedures; median=1), with a mean follow-up period of 48\u00b129 months from the last ablation. VF burden and frequency of shocks decreased significantly from 1.1\u00b12.1 per month before ablation to 0.003\u00b10.14 per month after the last ablation (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001). The Kaplan-Meier VF-free survival beyond 5 years after the last ablation was 95%. The only variable associated with a VF-free outcome in multivariable analysis was normalization of the type 1 Brugada ECG, both with and without sodium-channel blockade, after the ablation (hazard ratio, 0.078 [95% CI, 0.008 to 0.753];\n              <jats:italic>P<\/jats:italic>\n              =0.0274). There were no arrhythmic or cardiac deaths. Complications included hemopericardium in 4 (2.5%) patients.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Ablation treatment is safe and highly effective in preventing VF recurrence in high-risk BrS. Prospective studies are needed to determine whether it can be an alternative treatment to implantable cardioverter-defibrillator implantation for selected patients with BrS.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Registration:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT04420078.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.122.063367","type":"journal-article","created":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T09:00:36Z","timestamp":1679648436000},"page":"1568-1578","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":81,"title":["Long-Term Outcomes of Brugada Substrate Ablation: A Report from BRAVO (Brugada Ablation of VF Substrate Ongoing Multicenter Registry)"],"prefix":"10.1161","volume":"147","clinical-trial-number":[{"clinical-trial-number":"nct04420078","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8139-0343","authenticated-orcid":true,"given":"Koonlawee","family":"Nademanee","sequence":"first","affiliation":[{"name":"Center of Excellence in Arrhythmia Research and Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (K.N., A.K., S.V.)."},{"name":"Pacific Rim Electrophysiology Research Institute at Bumrungrad Hospital, Bangkok, Thailand (K.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fa-Po","family":"Chung","sequence":"additional","affiliation":[{"name":"Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (F.-P.C., S.-A.C.)."},{"name":"National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan (F.-P.C., S.-A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8348-9320","authenticated-orcid":true,"given":"Frederic","family":"Sacher","sequence":"additional","affiliation":[{"name":"Cardiac Arrhythmia Department, Bordeaux University Hospital, LIRYC Institute, Universit\u00e9 Bordeaux, France (F.S., M. Hocini, M. Haissaguerre)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiko","family":"Nogami","sequence":"additional","affiliation":[{"name":"University of Tsukuba, Division of Cardiology, Ibaraki, Japan (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9368-519X","authenticated-orcid":true,"given":"Hiroshi","family":"Nakagawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenyang","family":"Jiang","sequence":"additional","affiliation":[{"name":"Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China (C.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7957-8766","authenticated-orcid":true,"given":"Meleze","family":"Hocini","sequence":"additional","affiliation":[{"name":"Cardiac Arrhythmia Department, Bordeaux University Hospital, LIRYC Institute, Universit\u00e9 Bordeaux, France (F.S., M. Hocini, M. Haissaguerre)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8731-2853","authenticated-orcid":true,"given":"Elijah","family":"Behr","sequence":"additional","affiliation":[{"name":"St George\u2019s University of London and Cardiovascular Clinical Academic Group, St George\u2019s University Hospital NHS Foundation Trust, UK (E.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gumpanart","family":"Veerakul","sequence":"additional","affiliation":[{"name":"Preventive Heart and Lipid Clinic, Bangkok Heart Hospital, BDMS, Bangkok, Thailand (G.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaap","family":"Jan Smit","sequence":"additional","affiliation":[{"name":"Isala Klinieken Zwolle, the Netherlands (J.J.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0528-0852","authenticated-orcid":true,"given":"Arthur A.M.","family":"Wilde","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam University Medical Centre, University of Amsterdam, the Netherlands (A.A.M.W.)."},{"name":"European Reference Network for rare, low-prevalence, and complex diseases of the heart: ERN GUARD-HEART (A.A.M.W., M.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9085-0823","authenticated-orcid":true,"given":"Shih-Ann","family":"Chen","sequence":"additional","affiliation":[{"name":"Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (F.-P.C., S.-A.C.)."},{"name":"National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan (F.-P.C., S.-A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kohei","family":"Yamashiro","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Takatsuki General Hospital, Osaka, Japan (K.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichiro","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan (Y.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1444-090X","authenticated-orcid":true,"given":"Itsuro","family":"Morishima","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mithilesh K.","family":"Das","sequence":"additional","affiliation":[{"name":"Krannert Institute of Cardiology, University of Indiana, Indianapolis (M.K.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5738-1738","authenticated-orcid":true,"given":"Apichai","family":"Khongphatthanayothin","sequence":"additional","affiliation":[{"name":"Center of Excellence in Arrhythmia Research and Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (K.N., A.K., S.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saran","family":"Vardhanabhuti","sequence":"additional","affiliation":[{"name":"Center of Excellence in Arrhythmia Research and Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (K.N., A.K., S.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7644-6146","authenticated-orcid":true,"given":"Michel","family":"Haissaguerre","sequence":"additional","affiliation":[{"name":"Cardiac Arrhythmia Department, Bordeaux University Hospital, LIRYC Institute, Universit\u00e9 Bordeaux, France (F.S., M. Hocini, M. Haissaguerre)."},{"name":"European Reference Network for rare, low-prevalence, and complex diseases of the heart: ERN GUARD-HEART (A.A.M.W., M.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.cj-12-1352"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eut272"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.06.037"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.111.964577"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.628537"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.02.077"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.joa.2013.02.003"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.972612"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2016.12.001"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.117.005053"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2017.01.006"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2018.03.019"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.532614"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2016.07.025"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2016.08.025"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.032624"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2017.09.010"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.122.063367","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T07:36:13Z","timestamp":1715585773000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.122.063367"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,23]]},"references-count":17,"journal-issue":{"issue":"21","published-print":{"date-parts":[[2023,5,23]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.122.063367"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.122.063367","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,23]]},"assertion":[{"value":"2022-11-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-25","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-03-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}