Background: Brugada syndrome (BrS) is a cardiac channelopathy predisposing individuals to malignant ventricular arrhythmias (VAs) and sudden cardiac death. Substrate modification with catheter ablation (CA) has emerged as an interesting option to prevent recurrence of VA. Objective: This systematic review and meta-analysis aimed to assess the efficacy and safety of CA in patients with high-risk symptomatic BrS. Methods: We conducted a systematic review and meta-analysis of studies comparing CA with standard therapy in patients with symptomatic BrS. We systematically searched PubMed and Embase databases from inception to June 15, 2025. The primary endpoint was recurrence of malignant VA or appropriate implantable cardioverter-defibrillator therapy during follow-up. Random-effects models were used to calculate pooled risk ratios with 95% confidence intervals (CIs). Results: Five studies with 584 patients were included in the meta-analysis (331 ablation and 253 control). CA was associated with a 78% reduction in the primary endpoint compared with standard therapy (risk ratio 0.22; 95% CI 0.05–0.99; P = .049), with an estimated number needed to treat of 2.5. The time-to-event analysis confirmed the robustness of the findings (hazard ratio 0.17; 95% CI 0.04–0.73; P = .017). Procedural success rates were high: electrocardiogram normalization after Ajmaline challenge in 98.1% (95% CI 83.9–100.0), elimination of abnormal electrograms in 100% (95% CI 99.6–100.0), and noninducibility achieved in 94.9% of patients. Complication rate was low at 2.4% (95% CI 0.0–9.0). Conclusion: These findings support CA to prevent recurrence of VA in patients with symptomatic BrS on top of standard therapy, with high procedural success rates and an acceptable safety profile.
