Key result
Combined epicardial and endocardial radiofrequency ablation of late potentials in the right ventricular outflow tract prevented any further ventricular tachyarrhythmia episodes over 41 months in a patient with Brugada storm.
Why the study?
Does combined RVOT epicardial and endocardial late potential ablation prevent ventricular tachyarrhythmia in a patient with Brugada storm?
Case Report (n=1)
No
Does combined RVOT epicardial and endocardial late potential ablation prevent ventricular tachyarrhythmia in a patient with Brugada storm?
Combined endocardial and epicardial RVOT ablation of late potentials may be an effective acute management strategy for selected patients with Brugada storm.
May warrant consideration in refractory Brugada storm; leaves open efficacy and generalizability in larger cohorts.
A 34-year-old man with Brugada syndrome (BrS) presented with electrical storm, manifested as multiple appropriate shocks from his implantable cardioverter-defibrillator over a period of 7 hours. He had not tolerated prior treatment with quinidine, and had self-discontinued cilostazol citing persistent palpitations. After stabilization with intravenous isoproterenol, an electrophysiology study was performed but no spontaneous or induced ventricular ectopic beats were identified. A three-dimensional (3D) endocardial electro-anatomic map of the right ventricular outflow tract (RVOT), pulmonic valve, and pulmonary artery, as well as a 3D epicardial map of the RVOT, were created. Low voltage, complex, fractionated electrograms and late potentials were targeted for irrigated radiofrequency ablation both endocardially and epicardially. Post-procedure, he was maintained on cilostazol (referring clinician preference), and has had no further ventricular tachyarrhythmia episodes over the past forty-one months. We propose that this novel ablation strategy may be useful for acute management of selected patients with BrS.
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Saha et al. (2016) conducted a case report in Brugada syndrome with electrical storm (n=1). Combined epicardial and endocardial radiofrequency ablation was evaluated on Recurrence of ventricular tachyarrhythmia (VT/VF) episodes. Combined epicardial and endocardial radiofrequency ablation of late potentials in the right ventricular outflow tract prevented any further ventricular tachyarrhythmia episodes over 41 months in a patient with Brugada storm.
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