Key result
RVOT substrate modification is linked to ~80% freedom from recurrent arrhythmias in Brugada electrical storm.
Why the study?
Does substrate-based radiofrequency ablation of the right ventricular outflow tract prevent recurrent ventricular arrhythmias in patients with Brugada syndrome and electrical storm?
Observational (n=5)
Does substrate-based radiofrequency ablation of the right ventricular outflow tract prevent recurrent ventricular arrhythmias in patients with Brugada syndrome and electrical storm?
Substrate modification of the RVOT using radiofrequency ablation is a feasible and effective strategy to abolish the Brugada ECG pattern and prevent recurrent ventricular arrhythmias in patients with electrical storm.
May support RVOT ablation in Brugada electrical storm; hypothesis-generating and leaves open need for prospective trials.
BACKGROUND: Brugada syndrome (BrS) is known to cause malignant ventricular arrhythmia (VA) and sudden cardiac death (SCD). Patients with implantable cardioverter defibrillator (ICD) may experience recurrent shocks from ICD. Recent reports indicate that radiofrequency ablation (RFA) in BrS is feasible, and effective. Catheter ablation of premature ventricular complexes (PVCs) triggering VA and substrate modification of right ventricular outflow tract (RVOT) has been described. METHODS AND RESULTS: Five patients (4 males, age-23 to 32 years) with BrS and electrical storm (ES) despite being on isoprenaline infusion and cilostazol (phosphodiestrase-3 inhibitor) underwent 3 dimensional electroanatomic mapping and RFA. Ventricular fibrillation was easily inducible in two patients. Voltage map of right ventricle was created in sinus rhythm in all patients. Substrate modification of RVOT was performed endocardially in one patient, both endocardial and epicardial in three and only epicardially in one patient. Brugada pattern gradually resolved over one week in all patients post procedure. These patients completed follow up of median 40 months (1.5-70). One patient had inappropriate shock due to atrial fibrillation, one had an episode of VF and appropriate shock 24 months after the RFA. The remaining four patients had no device therapy or VA in device log on follow up. CONCLUSION: Abnormal myocardial substrate is observed in RVOT among patients with BrS. Substrate modification in these patients may abolish Brugada pattern on the ECG and prevents spontaneous VAs on long term follow up.
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Shelke et al. (2017) conducted an observational in Brugada syndrome with electrical storm (n=5). Radiofrequency ablation (substrate modification of RVOT) was evaluated on Recurrence of ventricular arrhythmias or device therapy. Substrate modification of the right ventricular outflow tract in 5 patients with Brugada syndrome and electrical storm prevented spontaneous ventricular arrhythmias in 4 patients over a median 40 months.
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