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. 2023 Sep 2;37(3):ivad160.
doi: 10.1093/icvts/ivad160.

3D mapping challenges in hybrid video-assisted thoracoscopic surgical ablation of Brugada syndrome

Ivan Eltsov  1   2 , Luigi Pannone  2 , Robbert Ramak  2 , Cinzia Monaco  2 , Domenico Giovanni Della Rocca  2 , Gezim Bala  2 , Rani Kronenberger  1 , Ingrid Overeinder  2 , Alexander Almorad  2 , Erwin Stroker  2 , Juan Sieira  2 , Pedro Brugada  2 , Andrea Sarkozy  2 , Gian-Battista Chierchia  2 , Carlo de Asmundis  2 , Mark La Meir  1
Affiliations

3D mapping challenges in hybrid video-assisted thoracoscopic surgical ablation of Brugada syndrome

Ivan Eltsov et al. Interdiscip Cardiovasc Thorac Surg. .

Abstract

Objectives: Brugada syndrome is a life-threatening disease with an arrhythmogenic substrate located in the epicardium of right ventricle outflow tract. Therefore, the correct region identification is crucial for a successful ablation procedure. Various mapping techniques can be adopted to elaborate this issue, but they were all initially developed for endovascular use.

Methods: In this study, we analysed 21 consecutive hybrid video-assisted thoracoscopic ablation of Brugada syndrome, performed using different mapping systems to identify the ablation target and confirm the elimination of arrhythmogenic substrate; 35 maps have been analysed.

Results: Acute success of epicardial right ventricle outflow tract ablation has been achieved in 100% of procedures, no periprocedural complications have been observed; HD Grid catheter showed higher area identification speed and faster fractionated potentials visualization; Rhythmia system has demonstrated the best map density; Carto 3 system showed a significant advantage in patient preparation time, but mapping speed was reduced due to focal catheter use only.

Conclusions: All tested electro anatomical mapping systems can be used for hybrid video-assisted thoracoscopic ablation with same clinical success; however, accuracy and efficacy of mapping systems are heterogenous and highly dependent on proper patient preparation, mapping system and physician skills.

Keywords: 3D mapping; Brugada syndrome; Cardiac surgery; Hybrid ablation; Video-assisted thoracoscopy.

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Figures

Figure 1:
Figure 1:
Typical patient preparation after disinfection and draping of sterile surgical field for hybrid video-assisted thoracoscopic Brugada syndrome ablation.
Figure 2:
Figure 2:
Different impedance tracking patching: (a) Ensite location patch placement guide; (b) Rhythmia system is using electrocardiography (ECG) patches to perform impedance-based localization, so patch placement is identical to 12-lead ECG; and (c) Carto 3 Patching diagram. (images are courtesy from Abbott and Biosense Webster companies)
Figure 3:
Figure 3:
Different catheters during epicardial mapping: (a) multipolar basket catheter; (b) multipolar grid catheter; and (c) linear quadripolar catheter.
Figure 4:
Figure 4:
Long low-voltage potentials on the right ventricle outflow tract from different catheters: (a) multipolar grid catheter; (b) multipolar basket catheter; and (c) linear quadripolar catheter.
Figure 5:
Figure 5:
Epicardial right ventricle outflow tract maps using different systems: (a) Ensite Precision map; (b) EnsiteX Voxel mode map; (c) Carto 3 map; and (d) Rhythmia map.
None
See this image and copyright information in PMC

References

    1. Sieira J, Dendramis G, Brugada P.. Pathogenesis and management of Brugada syndrome. Nat Rev Cardiol 2016;13:744–56. - PubMed
    1. Brugada P, Brugada J.. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol 1992;20:1391–6. - PubMed
    1. Rizzo A, de Asmundis C, Brugada P, La Meir M, Chierchia GB.. Ablation for the treatment of Brugada syndrome: current status and future prospects. Expert Rev Med Devices 2020;17:123–30. - PubMed
    1. Nademanee K, Veerakul G, Chandanamattha P, Chaothawee L, Ariyachaipanich A, JirasirirOJanakorn K. et al. Prevention of ventricular fibrillation episodes in Brugada syndrome by catheter ablation over the anterior right ventricular outflow tract epicardium. Circulation 2011;123:1270–9. - PubMed
    1. Wilde AA, Postema PG, Di Diego JM, Viskin S, Morita H, Fish JM. et al. The pathophysiological mechanism underlying Brugada syndrome: depolarization versus repolarization. J Mol Cell Cardiol 2010;49:543–53. - PMC - PubMed