Background:We conducted a multicenter study to evaluate mapping and ablation of ventricular fibrillation (VF) substrates or VF triggers in early repolarization syndromes (ERS) or J-wave syndrome (JWS). Methods: We studied 52 ERS patients (4 females; median age, 35 years) with recurrent VF episodes. Body-surface electrocardiographic imaging (ECGI) along with endocardial and epicardial electroanatomic mapping of both ventricles were performed during sinus rhythm and VF for localization of triggers, substrates, and drivers. Ablations were performed on:1) VF substrates defined as areas that had late depolarization abnormalities characterized by low voltage fractionated late potentials and 2) VF triggers. Results: Fifty-one of the 52 patients had detailed mapping which revealed two phenotypes: 1) Group 1 had late depolarization abnormalities predominantly at the right ventricular (RV) epicardium (n=40); and 2) Group 2 had no depolarization abnormalities (n=11). Group 1 can be subcategorized into 2 groups: Group 1A included 33 ERS patients with Brugada ECG pattern, and Group 1B included 7 ERS patients without Brugada ECG pattern. Late depolarization areas co-localize with VF driver areas. The anterior RV outflow tract (RVOT)/RV epicardium and the RV inferior epicardium are the major substrate sites for Group 1. The Purkinje network is the leading underlying VF trigger in Group 2 that had no substrates. Ablations were performed in 43 patients: 33 and 5 Group 1 patients had only VF substrate ablation and VF substrates plus VF trigger, respectively (mean 1.4 ± 0.6 sessions); 5 Group 2 patients and 1 without group classification had only Purkinje VF trigger ablation (mean 1.2 ± 0.4 sessions). Ablations were successful in reducing VF recurrences (p<0.0001). After follow-up of 31 ± 26 months, 39 (91%) had no VF recurrences. Conclusions: There are 2 phenotypes of ERS/JWS: 1) one with late depolarization abnormality as the underlying mechanism of high amplitude J-wave elevation that predominantly resides in the RVOT and RV inferolateral epicardium, serving as an excellent target for ablation; and 2) the other with pure ERS devoid of VF substrates, but with VF triggers that are associated with Purkinje sites. Ablation is effective in treating symptomatic ERS/JWS patients with frequent VF episodes. Non-Standard Abbreviations and AcronymsVF = Ventricular fibrillation. ERS = Early repolarization syndrome. BrS = Brugada syndrome JWS = J-wave syndrome RVOT = Right ventricular outflow tract RV = Right ventricle

Cardiac surgery performed during the symptomatic period of RSV infection is associated with a high risk of postoperative complications, especially postoperative pulmonary hypertension. These complications appeared to be more frequent and of greater severity in patients who had earlier surgery compared with those who had later surgery. More studies are needed regarding the proper timing of cardiac surgery in patients with congenital heart disease and RSV infection.

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Transient myocardial depression is not uncommon in patients with DSS. Cardiac dysfunction in children with DSS may contribute to the clinical severity and the degree of fluid overload in these patients.

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The mechanism of decreased cardiac output during toxic stage of DHF is complex. Decreased preload is accompanied by decreased left ventricular performance, and possibly a subnormal heart rate response in some patients.

Various benign bradyarrhythmias and ectopic beats are detected in patients with dengue virus infection during the convalescent stage.

BACKGROUND: Treatment options for high-risk Brugada syndrome (BrS) with recurrent ventricular fibrillation (VF) are limited. Catheter ablation is increasingly performed but a large study with long-term outcome data is lacking. We report the results of the multicenter, international BRAVO (Brugada Ablation of VF Substrate Ongoing Registry) for treatment of high-risk symptomatic BrS. METHODS: We enrolled 159 patients (median age 42 years; 156 male) with BrS and spontaneous VF in BRAVO; 43 (27%) of them had BrS and early repolarization pattern. All but 5 had an implantable cardioverter-defibrillator for cardiac arrest (n=125) or syncope (n=34). A total of 140 (88%) had experienced numerous implantable cardioverter-defibrillator shocks for spontaneous VF before ablation. All patients underwent a percutaneous epicardial substrate ablation with electroanatomical mapping except for 8 who underwent open-thoracotomy ablation. RESULTS: In all patients, VF/BrS substrates were recorded in the epicardial surface of the right ventricular outflow tract; 45 (29%) patients also had an arrhythmic substrate in the inferior right ventricular epicardium and 3 in the posterior left ventricular epicardium. After a single ablation procedure, 128 of 159 (81%) patients remained free of VF recurrence; this number increased to 153 (96%) after a repeated procedure (mean 1.2±0.5 procedures; median=1), with a mean follow-up period of 48±29 months from the last ablation. VF burden and frequency of shocks decreased significantly from 1.1±2.1 per month before ablation to 0.003±0.14 per month after the last ablation ( P <0.0001). The Kaplan-Meier VF-free survival beyond 5 years after the last ablation was 95%. The only variable associated with a VF-free outcome in multivariable analysis was normalization of the type 1 Brugada ECG, both with and without sodium-channel blockade, after the ablation (hazard ratio, 0.078 [95% CI, 0.008 to 0.753]; P =0.0274). There were no arrhythmic or cardiac deaths. Complications included hemopericardium in 4 (2.5%) patients. CONCLUSIONS: Ablation treatment is safe and highly effective in preventing VF recurrence in high-risk BrS. Prospective studies are needed to determine whether it can be an alternative treatment to implantable cardioverter-defibrillator implantation for selected patients with BrS. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04420078.