Impact of Atrial Fibrillation on the Outcome of Patients with Brugada Syndrome: A Meta-Analysis.

INTRODUCTION: Atrial fibrillation (AF) is common in patients with Brugada syndrome (BrS). The impact and significance of AF in this patient population needs to be further clarified. METHOD: We performed a systematic review and meta-analysis of studies comparing the risks of developing major arrhythmic events (MAEs) in patients with BrS with and without AF. Databases including MEDLINE, Embase, and Cochrane CENTRAL were searched from inception to July 2024, using appropriate search and MeSH terms. Data were sought on the comparison of patients with BrS with and without AF. The protocol was specified prior to the searches being performed, and standard meta-analytic techniques were used. RESULTS: Thirteen observational studies were included (a total of 5413 patients). A significant increase in MAEs was observed in patients with both BrS and AF (20.6% vs. 7.8%; OR 2.81, 95% CI 1.82-4.34; p < 0.0001; I2 = 46%). Significantly higher rates of syncope (33.3% vs. 23.4%; OR 1.97, 95% CI 1.04-3.76; p = 0.04, I2 = 59%) and a significant increase in all-cause mortality (11.3% vs. 3.7%; OR 4.21, 95% CI 1.69-10.45; p = 0.002, I2 = 0%) and sodium channel mutations (43.1% vs. 29.9%; OR 1.87, 95% CI 1.07-3.29; p = 0.028, I2 = 0%) were observed for patients with BrS and AF. CONCLUSIONS: Patients with both BrS and AF seem to have a more severe disease phenotype. More research into the added role of AF in risk stratification of asymptomatic BrS patients is needed, but the prognostic implications of AF may need to be considered when developing future personalised medicine approaches in the BrS population.