March 19, 2021Open Access
Parahisian pacing to unmask Brugada pattern with concomitant left bundle branch block and to document epicardial ablation endpoint in Brugada syndrome
Key Result
Parahisian pacing was utilized to unmask the Brugada ECG pattern in the setting of concomitant left bundle branch block to document the epicardial ablation endpoint.
Study Design
Type
Case Report
Structured PICO
Does Parahisian pacing unmask the Brugada pattern to document epicardial ablation endpoints in patients with Brugada syndrome and concomitant LBBB?
P
Population
Patients with Brugada syndrome and concomitant left bundle branch block (LBBB)
I
Intervention
Parahisian pacing during epicardial ablation
O
Outcome
Unmasking of Brugada pattern and documentation of epicardial ablation endpointsurrogate
Parahisian pacing may be a useful technique to unmask the Brugada ECG pattern and confirm ablation success in patients where it is obscured by LBBB.
Abstract
Brugada syndrome, traditionally described as a channelopathy affecting transmembrane sodium current, has been recognized as a structural disease affecting the epicardial right ventricular outflow tract (RVOT).1–3 This observation has been the basis for successful arrhythmic substrate ablation in these patients, with resolution of the Brugada pattern in the anterior precordial leads reported as a reliable procedural endpoint.4,5 However, the typical precordial electrocardiogram (ECG) pattern is obscured in patients with concomitant left bundle branch block (LBBB),6 making this a challenging observation in such patients.