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September 6, 2026EP EuropaceOpen Access

Arrhythmogenic substrate elimination for safe testosterone therapy in symptomatic Brugada syndrome patients

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Why the study?

Does epicardial radiofrequency ablation prevent ventricular arrhythmias in symptomatic Brugada syndrome patients on testosterone replacement therapy?

Population

2 symptomatic Brugada syndrome patients experiencing arrhythmic events while on testosterone replacement…

Design

Case_series

Key result

Epicardial radiofrequency ablation completely abolished abnormal electrograms and resulted in persistent ECG normalization and freedom from ventricular arrhythmias in two BrS patients on TRT.

Authors

GNGabriele NegroABAntonio BoccellinoANAntonio Napolano

Discussion

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Overview

May enable continued testosterone therapy without arrhythmia recurrence in Brugada syndrome; hypothesis-generating and requires prospective validation before clinical adoption.

Key Points

  • To evaluate the feasibility and efficacy of epicardial substrate mapping and radiofrequency ablation in symptomatic Brugada syndrome patients who must remain on testosterone replacement therapy.
  • Performed high-density epicardial mapping and radiofrequency catheter ablation in two patients (N=2) with symptomatic Brugada syndrome receiving testosterone replacement therapy.
  • Identified and targeted areas exhibiting prolonged and fragmented electrograms within the right ventricular outflow tract and anterior right ventricular wall.
  • High-density mapping successfully identified arrhythmogenic substrate in the right ventricular outflow tract and anterior wall, which was completely abolished via radiofrequency ablation in both patients.
  • Following ablation, both patients achieved persistent electrocardiogram normalization and remained completely free from ventricular arrhythmias during follow-up despite continuous testosterone replacement therapy.

Study Design

Type

Case Report (n=2)

Structured PICO

Does epicardial radiofrequency ablation prevent ventricular arrhythmias in symptomatic Brugada syndrome patients on testosterone replacement therapy?

P
Population
2 symptomatic Brugada Syndrome patients experiencing arrhythmic events while on testosterone replacement therapy.
I
Intervention
Epicardial substrate mapping and radiofrequency ablation (RFA)
O
Outcome
Normalization of ECG and freedom from ventricular arrhythmiashard clinical

Epicardial radiofrequency ablation successfully eliminated arrhythmogenic substrates and prevented ventricular arrhythmias in two Brugada syndrome patients requiring ongoing testosterone replacement therapy.

Trending Research#6 this week

Late-breaking 12-month data from the FlexPulse IDE study, presented at ESC 2026, demonstrate favorable safety and effectiveness for a new ablation catheter in treating complex atrial fibrillation cases.

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Cite This Study

Negro et al. (2023) conducted a case report in Brugada Syndrome (n=2). Epicardial radiofrequency ablation was evaluated on Abolition of abnormal electrograms, normalization of ECG, and freedom from ventricular arrhythmias. Epicardial radiofrequency ablation completely abolished abnormal electrograms and resulted in persistent ECG normalization and freedom from ventricular arrhythmias in two BrS patients on TRT.

synapsesocial.com/papers/6a9d2508acf8cb4fc9b81f50https://doi.org/10.1093/europace/euad254
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Also Consider

Synapse has enriched one closely related paper. Consider it for comparative context:

  1. 1Disappearance of the Brugada‐Type Electrocardiogram After Surgical Castration:2003 · 172 citations