Epicardial Substrate Ablation in Brugada Syndrome

Wilde, Arthur A.M.; Nademanee, Koonlawee

doi:10.1161/circep.115.003500

Cited by 16 publications

(9 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The mechanism by which substrate modification ablation prevents VT/VF in BrS remains uncertain. It is possible that by epicardial ablation, transmural dispersion of conduction-repolarisation is normalised to abolish the ST elevation on resting ECG and possibility of phase 2 re-entry [18]. Alternatively, by abolishing epicardial channels demarcated by fractionated electrograms as a result of conduction delay local re-entry and wavebreak degenerating into VF are prevented [19,20].…”

Section: Discussionmentioning

confidence: 99%

Ripple-Mapping for the Detection of Long Duration Action Potential Areas in Patients with Brugada Syndrome

Providência

Cavaco

Carmo

et al. 2018

Preprint

View full text Add to dashboard Cite

Purpose: Catheter ablation has been recently utilised in patients with Brugada syndrome to prevent ventricular arrhythmias. We hypothesized whether a mapping algorithm "Ripple-mapping" would be able to rapidly identify the areas of long-duration multicomponent electrograms which constitute the targets for ablation for an automated strategy. Methods:Ripple-Mapping analysis was performed in all patients undergoing catheter ablation of Brugada syndrome in 2 centers. The activity propagation pattern determined by Ripple-Mapping was assessed, and areas of long duration potentials identified by visual inspection. The area of interest with long-duration potentials was correlated with the location of the ablation lesions.Results: Detection of long duration potentials was possible in all four patients in this analysis. Points marking the ablation area in 2 patients were a perfect match to abnormal areas identified by Ripple-mapping. However, in 2 patients Ripple-mapping identified additional sites of long duration potentials which were not ablated. Acute and mid-term normalization of the ECG pattern was observed in three patients, and all these were free from arrhythmia relapse during a 10.3±3.2 months follow-up. In one patient, who had no ECG normalization and had arrhythmia relapse, the ablated area corresponded to <25% of the Ripple-map region of interest. Conclusions:This study shows the potential use of Ripple-mapping for identifying areas of long duration multicomponent electrograms in patients with Brugada syndrome and recurrent ventricular arrhythmias. This technique enables the rapid definition of an area of interest which should then be validated by the operator before performing ablation with an end-point of ECG normalisation.

show abstract

Section: Discussionmentioning

confidence: 99%

Ripple-Mapping for the Detection of Long Duration Action Potential Areas in Patients with Brugada Syndrome

Providência

Cavaco

Carmo

et al. 2018

Preprint

View full text Add to dashboard Cite

show abstract

“…[26] With the progress made in recent years, there is hope that RFA might even offer a ‘cure’ for selected patients. [61]…”

Section: Advances In Managementmentioning

confidence: 99%

Brugada Syndrome: Progress in Genetics, Risk Stratification and Management

Romero

Avendaño

et al. 2019

Arrhythm Electrophysiol Rev

View full text Add to dashboard Cite

Brugada syndrome (BrS) is one of the most common causes of sudden cardiac death in normal structural heart individuals. First characterised in 1992, the global prevalence of BrS is unclear, with estimates placing it at around 0.05% and presenting most frequently in southeast Asian countries. This review aims to summarise the development in the understanding of BrS and, importantly, progress in its management, underpinned by knowledge regarding its genetics and molecular mechanisms. It also provides update on risk stratification and promising new therapies for BrS, including epicardial ablation. Future studies are required to increase understanding of the pathogenesis of this disease and to guide clinical practice.

show abstract

Section: Ablationmentioning

confidence: 99%

“…The authors did not rely on only low voltage areas in substrate identification, which could be affected by confounding factors such as tissue contact, pericardial fat, and fluid accumulation [63]. The study group expanded to over 50 patients in whom the authors were able to eliminate the Brugada ECG pattern without VF recurrence in a median follow-up of 3 years [63]. In a study involving 14 BrS patients with ICD, Brugada et al performed epicardial contact mapping (after endocardial mapping) and ablation of a substrate which consisted of RV abnormal electrograms (amplitude <1.5 mV or wide duration [>80 ms], multiple [>3] or delayed components, beyond the QRS complex end) in low-voltage areas (<1.5 mV) during sinus rhythm, after flecainide administration [64].…”

Section: Ablationmentioning

confidence: 99%

Brugada syndrome: new concepts and algorithms in management (RCD code: V 1A.1)

Matusik

Rydlewska

Pudło

et al. 2018

Journal of Rare Cardiovascular Diseases

View full text Add to dashboard Cite

Clinical manifestation of Brugada syndrome (BrS) mainly results from polymorphic ventricular arrhythmias and includes sudden cardiac arrest (SCA). The Brugada sign, besides being present in true BrS, may result from different causes. Moreover, electrocardiogram findings in some clinical situations may resemble the BrS electrocardiographic pattern. Thus, differential diagnosis is crucial in the proper management of patients suspected of having BrS. Lifestyle modifications and close follow-up with or without pharmacologic treatment and/or implantable cardioverter-defibrillator placement constitute the most common approach to managing BrS patients. However, the role of ablation in BrS treatment is increasing. Due to diagnostic and therapeutic difficulties, the management of BrS is often challenging. This review provides new concepts and algorithms in the diagnostics and treatment of patients suspected of having BrS. JRCD 2017; 3 (5): 151-160

show abstract

Epicardial Substrate Ablation in Brugada Syndrome

Cited by 16 publications

References 21 publications

Ripple-Mapping for the Detection of Long Duration Action Potential Areas in Patients with Brugada Syndrome

Ripple-Mapping for the Detection of Long Duration Action Potential Areas in Patients with Brugada Syndrome

Brugada Syndrome: Progress in Genetics, Risk Stratification and Management

Brugada syndrome: new concepts and algorithms in management (RCD code: V 1A.1)

Contact Info

Product

Resources

About