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Case Reports
. 2021 May 15;12(5):4520-4524.
doi: 10.19102/icrm.2021.120502. eCollection 2021 May.

Catheter Ablation for Brugada Syndrome

Dingxin Qin  1 , Weeranun D Bode  1 , E Kevin Heist  1 , Steven A Lubitz  1 , Pasquale Santangeli  2 , Jeremy Ruskin  1 , Moussa Mansour  1
Affiliations
Case Reports

Catheter Ablation for Brugada Syndrome

Dingxin Qin et al. J Innov Card Rhythm Manag. .

Abstract

We report a case of catheter ablation of Brugada syndrome in a patient with refractory ventricular fibrillation despite quinidine therapy. We performed epicardial substrate mapping, which identified an area of abnormal fractionated, prolonged electrogram in the anterior right ventricular outflow tract. Warm saline infusion into the pericardial space induced further delay of the local electrogram, consistent with Brugada syndrome physiology. Coronary angiography confirmed that the area was distant from major coronary arteries. Ablation was performed in this area, which eliminated local abnormal electrograms and led to the disappearance of coved-type ST elevation in V1-V2. No ventricular fibrillation had recurred by five months of follow-up.

Keywords: Brugada syndrome; catheter ablation; ventricular fibrillation.

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Conflict of interest statement

Dr. Heist receives consulting fees from Abbott, Boston Scientific, Medtronic, and Pfizer; research grants from Abbott, Biotronik, and Pfizer; and honoraria from Medtronic, Biotronik, and Abbott. Dr. Lubitz is supported by a National Institutes of Health grant (1R01HL139731) and an American Heart Association grant (18SFRN34250007); receives sponsored research support from Bristol Myers Squibb/Pfizer, Bayer AG, Boehringer Ingelheim, and Fitbit; and has consulted for Bristol Myers Squibb/Pfizer and Bayer AG. Dr. Santangeli is a consultant for Abbott, Biosense Webster, and Baylis and has receive research grants from Biosense Webster and Attune Medical. Dr. Ruskin has served as a consultant for Acesion Pharma, Advanced Medical Education, Correvio, Hanover Medical, InCarda, Janssen, LuxCath, Medtronic, Novartis, and Pfizer and has equity interests in Ablacor, Celero Systems, Element Science, Gilead, Infobionic, NewPace, and Portola. Dr. Mansour has served as a consultant for Biosense Webster, Abbott, Medtronic, Boston Scientific, Janssen, Philips, Novartis, Baylis, and SentreHeart; has received research grants from Biosense Webster, Abbott, Boston Scientific, Medtronic, Pfizer, and Boehringer Ingelheim; and has equity interests in EPD Solutions, NewPace, and Affera. The other authors report no conflicts of interest for the published content.

Figures

Figure 1:
Figure 1:
Epicardial activation mapping of the right ventricle. A: Normal RV electrogram duration was measured from the beginning of the QRS complex. B and C: Abnormal electrogram duration in the RVOT area, which extended beyond the end of the QRS complex, was measured from both the beginning and the end of the QRS complex. The A, B, and C in circles above correspond to the three electrograms below from left to right.
Figure 2:
Figure 2:
Integration of the epicardial activation map with a CARTOSOUND® image and 3D CT scan with RVOT electrograms before (A) and after (B) pericardial warm saline infusion. The electrogram became more delayed and fractionated after warm saline infusion. The duration of the electrogram was measured from the beginning of the QRS complex.
Figure 3:
Figure 3:
Left and right coronary angiograms before ablation. The ablation catheter was placed in the epicardial RVOT area at a safe distance from the left (A) and right (B) coronary arteries.
Figure 4:
Figure 4:
Epicardial activation map postablation. Ablation lesions are shown. The fractionated delayed electrograms in the RVOT area were eliminated. As compared with the preablation ECG (A), the postablation ECG (B) showed the disappearance of the coved-type ST elevation in V1–V2. C: An example of an electrogram on the ablation catheter before and after ablation.
See this image and copyright information in PMC

References

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