Ventricular fibrillation (VF) is a common cause of sudden cardiac death in patients with channelopathies, particularly in the young population. Although pharmacological treatment, cardiac sympathectomy, and implantable cardioverter defibrillators (ICD) have been the mainstay in the management of VF in patients with channelopathies, they are associated with significant adverse effects and complications, leading to poor quality of life. Given these drawbacks, catheter ablation has been proposed as a therapeutic option for patients with channelopathies. Advances in imaging techniques and modern mapping technologies have enabled increased precision in identifying arrhythmia triggers and substrate modification. This has aided our understanding of the underlying pathophysiology of ventricular arrhythmias in channelopathies, highlighting the roles of the Purkinje network and the epicardial right ventricular outflow tract in arrhythmogenesis. This review explores the role of catheter ablation in managing the most common channelopathies (Brugada syndrome, congenital long QT syndrome, short QT syndrome, and catecholaminergic polymorphic ventricular tachycardia). While the initial results for ablation in Brugada syndrome are promising, the long-term efficacy and durability of ablation in different channelopathies require further investigation. Given the genetic and phenotypic heterogeneity of channelopathies, future studies are needed to show whether catheter ablation in patients with channelopathies is associated with a reduction in VF, and psychological distress stemming from recurrent ICD shocks, particularly relative to other available therapeutic options (e.g., quinidine in high-risk Brugada patients).

中文翻译：

---

导管消融治疗通道病：什么时候少才是多？

心室颤动（VF）是通道病患者（尤其是年轻人）心源性猝死的常见原因。尽管药物治疗、心脏交感神经切除术和植入式心律转复除颤器 (ICD) 一直是治疗离子通道病患者心室颤动的主要方法，但它们与显着的不良反应和并发症相关，导致生活质量差。鉴于这些缺点，导管消融已被提议作为通道病患者的一种治疗选择。成像技术和现代绘图技术的进步提高了识别心律失常触发因素和基质修饰的精度。这有助于我们了解通道病中室性心律失常的潜在病理生理学，强调浦肯野网络和心外膜右心室流出道在心律失常发生中的作用。本综述探讨了导管消融在治疗最常见通道病（Brugada 综合征、先天性长 QT 综合征、短 QT 综合征和儿茶酚胺能多形性室性心动过速）中的作用。虽然 Brugada 综合征消融的初步结果令人鼓舞，但不同通道病消融的长期疗效和持久性需要进一步研究。鉴于通道病的遗传和表型异质性，未来的研究需要证明通道病患者的导管消融是否与心室颤动的减少以及反复ICD电击引起的心理困扰有关，特别是相对于其他可用的治疗方案（例如奎尼丁）高危 Brugada 患者）。