Epicardial radiofrequency ablation eliminated local abnormal ventricular activity and normalized the electrocardiogram in a patient with gene-negative Brugada syndrome.
Case Report (n=1)
Epicardial radiofrequency ablation of the right ventricular outflow tract successfully eliminated local abnormal ventricular activity and normalized the ECG in a patient with gene-negative Brugada syndrome.
BACKGROUND: Epicardial ablation for Brugada syndrome targeting abnormal right ventricular outflow tract (RVOT) substrate with local abnormal ventricular activity (LAVA) demonstrated efficacy in European trials but remains uncommon in the United States. CASE SUMMARY: A 51-year-old man with type II Brugada pattern, febrile syncope, inducible ventricular fibrillation, and negative genetic testing declined implantable cardiac-defibrillator implantation. Electroanatomic mapping revealed local abnormal ventricular activation in the RVOT epicardium. Procainamide provoked type I Brugada pattern and prolongation of local RVOT activation. Radiofrequency ablation eliminated LAVA and normalized the electrocardiogram. DISCUSSION: Dynamic correlation of accentuated LAVA with procainamide provocation of type I Brugada pattern implicates delayed depolarization as the mechanism for pseudo-ST-segment changes in Brugada syndrome.
Byers et al. (Sex,) realizaram um relato de caso no Síndrome de Brugada Negativo para Genes (n=1). A ablação epicárdica por radiofrequência foi avaliada na eliminação da atividade ventricular anormal local (LAVA) e normalização do eletrocardiograma. A ablação epicárdica por radiofrequência eliminou a atividade ventricular anormal local e normalizou o eletrocardiograma em um paciente com síndrome de Brugada negativo para genes.