Mapping and Ablation of Ventricular Fibrillation Associated With Long-QT and Brugada Syndromes

Haı̈ssaguerre, Michel; Extramiana, Fabrice; Hocini, Mélèze; Cauchemez, B; Jaı̈s, Pierre; Cabrera, José Ángel; Farre, Geronimo; Leenhardt, Antoine; Sanders, Prashanthan; Scavée, Christophe; Hsu, Li Fern; Weerasooriya, Rukshen; Shah, Dipen; Frank, Robert; Maury, Philippe; Delay, Marc; Garrigue, Stéphane; Clémenty, Jacques

doi:10.1161/01.cir.0000088781.99943.95

Cited by 466 publications

(326 citation statements)

References 8 publications

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“…The mechanism of VF arising from the RV in the Brugada syndrome is thought be due to phase 2 reentry, originally described by Krishnan and Antzelevitch [11]. Haissaguerre et al described successful catheter ablation in three patients with the Brugada syndrome [12]. In two of the three patients, catheter ablation was successfully performed in the RVOT.…”

Section: Discussionmentioning

confidence: 97%

Successful catheter ablation of focal ventricular fibrillation originating from the right ventricle

Suh

Fowler

Yeh

et al. 2009

J Interv Card Electrophysiol

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Sudden cardiac death from ventricular fibrillation (VF) typically occurs in patients with structural heart disease, but in 5 to 10 percent VF is "idiopathic," occurring in normal hearts. Recently, there has been the description and growing recognition of patients with VF that has a focal origin, the common sites being in the right ventricular outflow tract (RVOT) and sites in the left ventricle. A focus within the right ventricle outside the RVOT is rare. We present a case of a woman with VF storm that was localized to the inferobasal right ventricle and was successfully treated with radiofrequency ablation.

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Section: Discussionmentioning

confidence: 97%

Successful catheter ablation of focal ventricular fibrillation originating from the right ventricle

Suh

Fowler

Yeh

et al. 2009

J Interv Card Electrophysiol

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“…1,4 Radiofrequency catheter ablation was first described to abolish the triggers of VF in these patients, 5 however, it can be applied only in selected cases, when triggering premature ventricular complexes are present at the time of the procedure. The novel approach to preventively ablate the substrate located in the anterior epicardial region of the RVOT showed promising results by reducing the number of VF episodes in Brugada syndrome patients with ICD therapy.…”

Section: R Esum Ementioning

confidence: 99%

Ablation of the Epicardial Substrate in the Right Ventricular Outflow Tract in a Patient With Brugada Syndrome Refusing Implantable Cardioverter Defibrillator Therapy

Özcan

Osztheimer

Treuer

et al. 2014

Canadian Journal of Cardiology

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Brugada syndrome is associated with a high risk of sudden cardiac death. Currently, the cornerstone of therapy is implantation of an implantable cardioverter defibrillator (ICD). Recently, a novel approach to preventively ablate the substrate located in the anterior epicardial region of the right ventricular outflow tract showed promising results by reducing the number of ventricular fibrillation episodes in patients with ICD. Here we report on a patient with Brugada syndrome who refused ICD therapy in whom a successful epicardial right ventricular outflow tract substrate ablation was performed. In some special cases, ablation therapy might be considered as the sole therapeutic option for these patients. R ESUM ELe syndrome de Brugada est associe à un risque eleve de mort cardiaque subite. Actuellement, la pierre angulaire du traitement est l'implantation d'un defibrillateur cardioverteur implantable (DCI). Recemment, une nouvelle approche pour proceder de manière preventive à l'ablation du substrat localise dans la region epicardique anterieure de la chambre de chasse du ventricule droit a montre des resultats prometteurs en reduisant le nombre d'episodes de fibrillation auriculaire chez les patients portant un DCI. Nous rapportons ici le cas d'un patient souffrant du syndrome de Brugada qui a refuse le traitement par DCI chez qui une ablation du substrat epicardique de la chambre de chasse du ventricule droit a ete reussie. Dans certains cas particuliers, le traitement par ablation pourrait être considere comme la seule option therapeutique chez ces patients.A 31-year-old male patient with recurrent short lasting paroxysmal palpitations, once leading to syncope, was referred to our Electrophysiology Department for evaluation. Apart from congenital hypoplasia of both upper and lower extremities he had no known disease in his medical history and physical examination did not reveal any other abnormalities. His family history of sudden cardiac death (SCD) was unknown because he was adopted in infancy. Twelve-lead resting electrocardiogram (ECG) showed a type II Brugada pattern, with a characteristic "saddle back" pattern ST segment elevation most prominently in V 2 and V 3 and a negative T-wave in lead V 1 without fragmentation or inferolateral early repolarization (Fig. 1). Echocardiography and routine laboratory tests were normal. A 24-hour Holter ECG recording revealed short runs of atrial ectopy only.During the electrophysiology study, atrial fibrillation developed during catheter positioning, which terminated spontaneously. No other supraventricular or ventricular arrhythmia was inducible by pacing manoeuvres (2 extrasystoles with a coupling interval until refractoriness or reaching 200 ms at 550, 400, and 330 ms base drive, respectively). Then ajmaline with a dose of 1 mg/kg of body weight was given intravenously over 10 minutes and we recorded a > 0.2 mV ST segment elevation in V 2 and evolution of a type I Brugada pattern (Fig. 1), however, no arrhythmia could be induced after the drug test. On the...

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“…PCs have an increased intracellular calcium‐membrane potential coupling gain and are sources of afterdepolarization and triggered activity in rabbit ventricles 11. PCs can be a source of continuous electrical activity during ventricular fibrillation12 and are also important in initiating ventricular arrhythmias in humans 13. High incidence of Ca 2+ transient wavelets/waves in diseased PCs are responsible for arrhythmias originating in the subendocardial Purkinje network postmyocardial infarction 14.…”

Section: Introductionmentioning

confidence: 99%

Small‐Conductance Calcium‐Activated Potassium Current in Normal Rabbit Cardiac Purkinje Cells

Reher

Wang

Hsueh

et al. 2017

JAHA

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BackgroundPurkinje cells (PCs) are important in cardiac arrhythmogenesis. Whether small‐conductance calcium‐activated potassium (SK) channels are present in PCs remains unclear. We tested the hypotheses that subtype 2 SK (SK2) channel proteins and apamin‐sensitive SK currents are abundantly present in PCs.Methods and ResultsWe studied 25 normal rabbit ventricles, including 13 patch‐clamp studies, 4 for Western blotting, and 8 for immunohistochemical staining. Transmembrane action potentials were recorded in current‐clamp mode using the perforated‐patch technique. For PCs, the apamin (100 nmol/L) significantly prolonged action potential duration measured to 80% repolarization by an average of 10.4 ms (95% CI, 0.11–20.72) (n=9, P=0.047). Voltage‐clamp study showed that apamin‐sensitive SK current density was significantly larger in PCs compared with ventricular myocytes at potentials ≥0 mV. Western blotting of SK2 expression showed that the SK2 protein expression in the midmyocardium was 58% (P=0.028) and the epicardium was 50% (P=0.018) of that in the pseudotendons. Immunostaining of SK2 protein showed that PCs stained stronger than ventricular myocytes. Confocal microscope study showed SK2 protein was distributed to the periphery of the PCs.Conclusions SK2 proteins are more abundantly present in the PCs than in the ventricular myocytes of normal rabbit ventricles. Apamin‐sensitive SK current is important in ventricular repolarization of normal PCs.

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Mapping and Ablation of Ventricular Fibrillation Associated With Long-QT and Brugada Syndromes

Abstract: Triggers from the Purkinje arborization or the right ventricular outflow tract have a crucial role in initiating ventricular fibrillation associated with the long-QT and Brugada syndromes. These can be eliminated by focal radiofrequency ablation.

Cited by 466 publications

References 8 publications

Successful catheter ablation of focal ventricular fibrillation originating from the right ventricle

Successful catheter ablation of focal ventricular fibrillation originating from the right ventricle

Ablation of the Epicardial Substrate in the Right Ventricular Outflow Tract in a Patient With Brugada Syndrome Refusing Implantable Cardioverter Defibrillator Therapy

Small‐Conductance Calcium‐Activated Potassium Current in Normal Rabbit Cardiac Purkinje Cells

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