Catheter ablation for electrical storm in Brugada syndrome: Results of substrate based ablation

Background Brugada syndrome (BrS) is known to cause malignant ventricular arrhythmia (VA) and sudden cardiac death (SCD). Patients with implantable cardioverter defibrillator (ICD) may experience recurrent shocks from ICD. Recent reports indicate that radiofrequency ablation (RFA) in BrS is feasible, and effective. Catheter ablation of premature ventricular complexes (PVCs) triggering VA and substrate modification of right ventricular outflow tract (RVOT) has been described. Methods and results Five patients (4 males, age-23 to 32 years) with BrS and electrical storm (ES) despite being on isoprenaline infusion and cilostazol (phosphodiestrase-3 inhibitor) underwent 3 dimensional electroanatomic mapping and RFA. Ventricular fibrillation was easily inducible in two patients. Voltage map of right ventricle was created in sinus rhythm in all patients. Substrate modification of RVOT was performed endocardially in one patient, both endocardial and epicardial in three and only epicardially in one patient. Brugada pattern gradually resolved over one week in all patients post procedure. These patients completed follow up of median 40 months (1.5–70). One patient had inappropriate shock due to atrial fibrillation, one had an episode of VF and appropriate shock 24 months after the RFA. The remaining four patients had no device therapy or VA in device log on follow up. Conclusion Abnormal myocardial substrate is observed in RVOT among patients with BrS. Substrate modification in these patients may abolish Brugada pattern on the ECG and prevents spontaneous VAs on long term follow up.

Keywords

Brugada syndrome, Electrical storm, Catheter ablation

Citation

Shelke Abhijeet, Tachil Ajit, Saggu Daljeet, Jesuraj Masilamani Lawrance, Yalagudri Sachin, Narasimhan Calambur. Catheter ablation for electrical storm in Brugada syndrome: Results of substrate based ablation. Indian Heart Journal. 2018 Mar; 70(2): 296-302

URI

https://imsear.searo.who.int/handle/123456789/191786

Collections

Indian Heart Journal

Full item page