Transient, Marked ST-Segment Elevation During Successful Epicardial Substrate Ablation in a Patient With Brugada Syndrome

Figures

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  Figure 1. Time Course of the Precordial Leads From the 12-Lead ECG and Ventricular LPs Recorded by the Signal-Averaged ECG (A) A typical type 1 Brugada-electrocardiogram (ECG) pattern with fragmented QRS complexes and a complete right bundle branch block (CRBBB) morphology were seen before ablation (Pre-Ab). Note that the CRBBB morphology disappeared temporarily 1 month later (Post-Ab 1 month). (B) The fQRSd, RMS40, and LAS40 during the follow-up after the ablation are shown. (C) The real signal-averaged ECG recordings at selective times are demonstrated. The late potentials (LPs) were consistently recorded before and after ablation except at post-Ab 1 month when the CRBBB morphology temporarily disappeared.

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  Figure 2. Bipolar Voltage Map and Abnormal Potentials in the Epicardial RV and ST-Segment Elevation in Lead V2 (A) An epicardial bipolar voltage map of the right ventricle is shown before the epicardial ablation, with a voltage range from 0.5 to 1.0 mV from the CARTO3 system. The epicardial right ventricular voltage map identified a wide low-voltage area in the anterior and inferior right ventricle and anterior right ventricular outflow tract (RVOT). In the left 2 panels, fractionated, delayed potentials and a prolonged duration are identified at the anterior right ventricle and RVOT (light blue tag) and inferior right ventricle (white tag). (B) Transient, marked ST-segment elevation in lead V2 was recorded during ablation, particularly at the border zone (e.g., the yellow tag on the CARTO map at the time of starting and stopping ablation). RFA = radiofrequency ablation.

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  Figure 3. Possible Mechanisms of the ST-Segment Elevation During Radiofrequency in Lead V2