Challenges in the treatment of patients with Brugada syndrome: The current role of ablation

Brugada syndrome is an inherited ion channelopathy associated with an increased risk for ventricular arrhythmia and sudden death. Current management strategies to reduce arrhythmic risk are limited, with few pharmacological options, which may be ineffective or cause side-effects leading to suboptimal dosing or cessation of treatment. Hence, there is substantial interest in determining the long-term efficacy and safety profile of catheter ablation, as well as targeting triggers and electrophysiological substrates for ventricular arrhythmia. With the recent publication of small, randomized trials including the BRAVE study, the level of evidence is improving. However, the balance of risk verses benefit across the arrhythmic risk spectrum remains unclear, and procedural technical challenges remain, particularly given that most patients will require an epicardial approach for catheter ablation. This review outlines the current evidence in the published literature and highlights gaps in knowledge that should be prioritized in future studies.