Key result
Hybrid thoracoscopic ablation for Brugada syndrome achieves 100% acute success across diverse mapping systems.
Why the study?
Arrhythmogenic substrate identification in the epicardium of the right ventricle outflow tract is crucial for ablation in Brugada syndrome, but available mapping techniques were initially developed for endovascular use.
How do different electroanatomical mapping systems compare in efficacy and accuracy during hybrid video-assisted thoracoscopic ablation of Brugada syndrome?
Observational (n=21)
No
How do different electroanatomical mapping systems compare in efficacy and accuracy during hybrid video-assisted thoracoscopic ablation of Brugada syndrome?
Various electroanatomical mapping systems can be safely and effectively used for hybrid video-assisted thoracoscopic ablation of Brugada syndrome, though they present different advantages in mapping speed, density, and preparation time.
May support hybrid ablation feasibility in Brugada syndrome; leaves open durability and optimal mapping system selection.
OBJECTIVES: Brugada syndrome is a life-threatening disease with an arrhythmogenic substrate located in the epicardium of right ventricle outflow tract. Therefore, the correct region identification is crucial for a successful ablation procedure. Various mapping techniques can be adopted to elaborate this issue, but they were all initially developed for endovascular use. METHODS: In this study, we analysed 21 consecutive hybrid video-assisted thoracoscopic ablation of Brugada syndrome, performed using different mapping systems to identify the ablation target and confirm the elimination of arrhythmogenic substrate; 35 maps have been analysed. RESULTS: Acute success of epicardial right ventricle outflow tract ablation has been achieved in 100% of procedures, no periprocedural complications have been observed; HD Grid catheter showed higher area identification speed and faster fractionated potentials visualization; Rhythmia system has demonstrated the best map density; Carto 3 system showed a significant advantage in patient preparation time, but mapping speed was reduced due to focal catheter use only. CONCLUSIONS: All tested electro anatomical mapping systems can be used for hybrid video-assisted thoracoscopic ablation with same clinical success; however, accuracy and efficacy of mapping systems are heterogenous and highly dependent on proper patient preparation, mapping system and physician skills.
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Eltsov et al. (2023) conducted an observational in Brugada syndrome (n=21). Different electroanatomical mapping systems (Ensite Precision, EnsiteX, Carto 3, Rhythmia) vs. Between-system comparison was evaluated on Acute procedural success (complete abolition of abnormal fractionated electrograms on epicardial right ventricle outflow tract). Hybrid video-assisted thoracoscopic ablation of Brugada syndrome using various electroanatomical mapping systems achieved 100% acute success with no periprocedural complications, though patient preparation time, mapping speed, and map density varied significantly between systems.
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