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Background: Brugada syndrome (BrS) is a genetic heart disease that predisposes individuals to ventricular arrhythmias and sudden cardiac death. Although implantable cardioverter-defibrillators (ICDs) and quinidine are primary treatments, recurrent BrS-triggered ventricular arrhythmias can persist. In this setting, epicardial substrate ablation has emerged as a promising alternative for symptomatic patients., Objective: Evaluate the effectiveness and safety of epicardial substrate ablation in patients with BrS., Methods: In this single-arm meta-analysis, we systematically searched PubMed, Embase, and Cochrane databases following PRISMA guidelines for studies including BrS patients with epicardial substrate ablation. Data were extracted, and statistical analysis was performed using random-effects modeling for proportional meta-analysis., Results: Thirteen cohort studies comprising 555 BrS patients were included. The mean age at enrollment was 42.6 ± 12.3 years; 82.7% were male patients, and 50% exhibited spontaneous type 1 Brugada electrocardiographic (ECG) pattern. Pooled analysis demonstrated resolution of the type 1 pattern in 91% of the cases (95% confidence interval [CI] 80-98%; I 2 = 86%) and elimination of abnormal electrograms in 91% (95% CI 78-99%; I 2 = 74%). Rates of recurrent VT/VF and appropriate ICD therapies during postablation follow-up were 12% (95% CI 4-21%; I 2 = 86%) and 8% (95% CI 2-18%; I 2 = 87%), respectively., Conclusion: Epicardial substrate ablation shows promise for patients with BrS experiencing BrS-triggered ventricular arrhythmias, offering therapeutic efficacy with an acceptable safety profile. High heterogeneity among studies highlights the need for further research and standardized protocols., Competing Interests: Disclosures Dr Ackerman is consultant for Abbot, Boston Scientific, Bristol Myers Squibb, Illumina, Invitae, Medtronic, Tenaya Therapeutics, and UpToDate. Dr Ackerman and Mayo Clinic have an equity/IP/royalty relationship with AliveCor, Anumana, ARMGO Pharma, Prolaio, and Solid Biosciences. However, none of these entities were involved in this study in any manner. The other authors have no conflicts of interest to disclose., (Copyright © 2025 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Introduction: Although sodium-glucose cotransporter-2 inhibitors (SGLT2i) were shown to lower hyperuricemic events in patients with type 2 diabetes mellitus (T2DM), the extent of this effect in the general population is yet to be elucidated. We performed an updated systematic review and meta-analysis on a large sample of patients with and without T2DM to evaluate the influence of SGLT2i therapy on clinically relevant hyperuricemic events, defined as the composite of acute gout flare episodes, acute anti-gout management or urate-lowering therapy initiation. Furthermore, we conducted a multivariate meta-regression to assess the relationship between different covariates and the pooled effect size., Materials and Methods: We systematically searched all reported outcomes of interest in patients on SGLT2i (PROSPERO: CRD42023442077) across PubMed, Scopus and Cochrane databases looking for randomized controlled trials, observational studies and post-hoc analyses since inception until August 2023., Results: Data from seven randomized controlled trials and seven observational studies were included for a total of 464,009 patients, 13,370 of whom did not have T2DM. A total of 50% of the patients included were on SGLT2i. The pooled analysis demonstrated that SGLT2i reduce clinically relevant hyperuricemic events by 33% (HR, 0.67; 95% CI, 0.59-0.77; I 2 =83%) regardless of the concomitant diagnosis of T2DM. The multivariate meta-regression on chronic kidney disease (CKD) showed a positive correlation on the pooled effect size., Conclusions: SGLT2i reduce the risk of developing hyperuricemic events regardless of the concomitant diagnosis of T2DM. The multivariate meta-regression on CKD showed a significant impact on the main outcome. Further studies are essential to investigate more conclusively the extent of these beneficial effects., (Copyright © 2024 SEEN and SED. Published by Elsevier España, S.L.U. All rights reserved.)