Epicardial substrate ablation in early repolarization syndrome patient with recurrent ventricular fibrillation

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  Figure 1. A: Resting electrocardiogram of a 21-year-old male patient showing marked early repolarization in inferolateral leads. This patient displays the notching phenotype with enlarged QRS (106 ms) and concomitant upward ST-segment elevation. B: Epicardial voltage map of right ventricle (RV; anterior view). C: Corresponding epicardial electrograms registered in anterior aspect of RV outflow tract and RV free wall. Fragmented low-amplitude signals, as well as late potentials, were recorded with a PentaRay catheter (Biosense Webster, Inc, Diamond Bar, CA) (black asterisk). D: Ablation lesions targeting microstructural abnormalities.