Epicardial ablation for prevention of ventricular fibrillation in a patient with Brugada Syndrome

Cortez‐Dias, Nuno; Plácido, Rui; Marta, Liliana; Bernardes, Ana; Sobral, S; Carpinteiro, L; Sousa, João de

doi:10.1016/j.repce.2014.01.005

Cited by 19 publications

(18 citation statements)

References 14 publications

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“…The results of endocardial mapping of the RVOT were partly contradictory. No significant abnormalities of endocardial EGs were detected in several studies . At the same time fractionation, prolonged duration of bipolar EGs and late activation were identified in the epicardial aspect of the RVOT.…”

Section: Introductionmentioning

confidence: 84%

“…Catheter ablation of the arrhythmogenic substrate in the RVOT identified by invasive endo‐ and epicardial mapping is a new, promising strategy for treatment of symptomatic BrS patients with recurrent episodes of VF. The fact that epi‐ and endocardial changes are present in patients with BrS may have potential clinical implications, because ablation of the arrhythmogenic substrate can be achieved by both endo‐ and epicardial ablation …”

Section: Discussionmentioning

confidence: 99%

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Simultaneous Non‐Invasive Epicardial and Endocardial Mapping in Patients With Brugada Syndrome: New Insights Into Arrhythmia Mechanisms

Rudic

Chaykovskaya

Tsyganov

et al. 2016

JAHA

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BackgroundThe underlying mechanisms of Brugada syndrome (BrS) are not completely understood. Recent studies provided evidence that the electrophysiological substrate, leading to electrocardiogram abnormalities and/or ventricular arrhythmias, is located in the right ventricular outflow tract (RVOT). The purpose of this study was to examine abnormalities of epicardial and endocardial local unipolar electrograms by simultaneous noninvasive mapping in patients with BrS.Methods and ResultsLocal epicardial and endocardial unipolar electrograms were analyzed using a novel noninvasive epi‐ and endocardial electrophysiology system (NEEES) in 12 patients with BrS and 6 with right bundle branch block for comparison. Fifteen normal subjects composed the control group. Observed depolarization abnormalities included fragmented electrograms in the anatomical area of RVOT endocardially and epicardially, significantly prolonged activation time in the RVOT endocardium (65±20 vs 38±13 ms in controls; P=0.008), prolongation of the activation‐recovery interval in the RVOT epicardium (281±34 vs 247±26 ms in controls; P=0.002). Repolarization abnormalities included a larger area of ST‐segment elevation >2 mV and T‐wave inversions. Negative voltage gradient (−2.5 to −6.0 mV) between epicardium and endocardium of the RVOT was observed in 8 of 12 BrS patients, not present in patients with right bundle branch block or in controls.ConclusionsAbnormalities of epicardial and endocardial electrograms associated with depolarization and repolarization properties were found using NEEES exclusively in the RVOT of BrS patients. These findings support both, depolarization and repolarization abnormalities, being operative at the same time in patients with BrS.

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Section: Introductionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Simultaneous Non‐Invasive Epicardial and Endocardial Mapping in Patients With Brugada Syndrome: New Insights Into Arrhythmia Mechanisms

Rudic

Chaykovskaya

Tsyganov

et al. 2016

JAHA

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“…Case reports have been published in support of these effects. 311 Additional evidence in support of the effectiveness of epicardial substrate ablation was provided by Sacher et al and Shah et al 130, 312 …”

Section: Update On Approaches To Therapy Of Brs and Ersmentioning

confidence: 90%

J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge

et al. 2016

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“…Since then, case reports have been published in support of these effects. 124 Ablation therapy can be life-saving in otherwise uncontrollable cases, or cases in which ICD therapy is impractical (e.g. contraindications or financial hardship in developing countries).…”

Section: Approach To Therapymentioning

confidence: 99%

Novel therapeutic strategies for the management of ventricular arrhythmias associated with the Brugada syndrome

Patocskai

Antzelevitch

2015

Expert Opinion on Orphan Drugs

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Introduction Brugada syndrome (BrS) is an inherited cardiac arrhythmia syndrome characterized by prominent J waves appearing as distinct coved type ST segment elevation in the right precordial leads of the ECG. It is associated with a high risk for sudden cardiac death. Areas Covered We discuss 1) ECG manifestations of BrS which can be unmasked or aggravated by sodium channel blockers, febrile states, vagotonic agents, as well as tricyclic and tetracyclic antidepressants; 2) Genetic basis of BrS; 3) Ionic and cellular mechanisms underlying BrS; 4) Therapy involving devices including an implantable cardioverter defibrillator (ICD); 5) Therapy involving radiofrequency ablation; and 6) Therapy involving pharmacological therapy which is aimed at producing an inward shift in the balance of the currents active during phase 1 of the right ventricular action potential either by boosting calcium channel current (isoproterenol, cilostazol and milrinone) or by inhibition of transient outward current Ito (quinidine, bepridil and the Chinese herb extract Wenxin Keli). Expert Opinion This review provides an overview of the clinical and molecular aspects of BrS with a focus on approaches to therapy. Available data suggest that agents capable of inhibiting the transient outward current Ito can exert an ameliorative effect regardless of the underlying cause.

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Epicardial ablation for prevention of ventricular fibrillation in a patient with Brugada Syndrome

Cited by 19 publications

References 14 publications

Simultaneous Non‐Invasive Epicardial and Endocardial Mapping in Patients With Brugada Syndrome: New Insights Into Arrhythmia Mechanisms

Simultaneous Non‐Invasive Epicardial and Endocardial Mapping in Patients With Brugada Syndrome: New Insights Into Arrhythmia Mechanisms

J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge

Novel therapeutic strategies for the management of ventricular arrhythmias associated with the Brugada syndrome

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