Transcatheter ablation in patients with Brugada syndrome

Figures

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  Figure 1. The flowchart describes the patient population of the registry.

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  Figure 2. Substrate mapping. The figure is divided in two main panels: left panel describes the mapping phase in basal conditions, right panel describes the substrate mapping after ajmaline infusion. Particularly, in each panel the 12-lead ECG, the local activation time map of the epicardium and the local intracardiac potential are displayed. In all panels, V5 and V6 record V1 and V2 in the II intercostal space. The green maps represent the right ventricle (endocardial mapping) and the red-purple maps are related to the epicardial mapping. In both epicardial maps black dots trace the right coronary and all maps are synchronized with the fluoroscopic image (anteroposterior view with the wire in the pericardial space). Analysing the local activation time map in basal conditions (spontaneous type I ECG on the left), an area of late activation potentials (purple area) can be identified in the epicardial side of the right ventricular outflow tract, as displayed in the IC signals (A–D).

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  Figure 3. Ablation phase. The picture is divided in two main panels: in the left panel the ablation tags are displayed on the activation map after ajmaline infusion (the target area characterized by late activation potentials is covered by the ablation tags). The right panel describes the activation map after radiofrequency ablation: the epicardial map is red because no more late potentials are detected. The 12-lead ECG after ajmaline infusion and after RF ablation are displayed at the external sides of the figure (left and right, respectively); V5 and V6 records V1 and V2 in II intercostal space. The green maps represent the right ventricle (endocardial mapping), and the other maps are related to the epicardial mapping. In both epicardial maps black dots trace the right coronary and all maps are synchronized with the fluoroscopic image (anteroposterior view with the wire in the pericardial space).

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  Figure 4. (A) 12-lead ECG recorded after ajmaline challenge, V5 and V6 recorded in II intercostal space, right and left parasternal line, respectively as described in text. (B) Zoom of V5–V6 (modified V1 and V2) and standard V1–V2 during ajmaline infusion. (C) BrS ECG pattern modification during ablation: J wave abolition combined with change of JT segment with complete disappearance of coved pattern: orange ECG recorded in modified V1 and V2 leads in II intercostal space (V5 and V6), blue line records of traditional V1 and V2 during radiofrequency; superimposed red line of ajmaline ECG before ablation. Yellow numbers represent the percentage grade of correlation between basal ECG and ECG recorded during radiofrequency application in each lead.

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  Figure 5. The picture highlights the differences in the 12-lead ECG during the procedure and after 3-month follow-up. V5 and V6 records V1 and V2 in II intercostal space. (A) Ablation procedure: ECGs in basal conditions (spontaneous type I), after ajmaline infusion and at the end of the procedure (after radiofrequency ablation). (B) 3-month follow-up: ECGs in basal conditions and after ajmaline infusion.