Combined Right Ventricular Outflow Tract Epicardial and Endocardial Late Potential Ablation for Treatment of Brugada Storm: A Case Report and Review of the Literature

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• 作者：Sandeep A. Saha ; Kousik Krishnan ; Christopher Madias…
• 关键词：Brugada syndrome ; Implantable cardioverter ; defibrillator ; Late potentials ; Radiofrequency ablation
• 刊名：Cardiology and Therapy
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：5
• 期：2
• 页码：229-243
• 全文大小：4359KB
• 刊物主题：Internal Medicine; Cardiology;
• 出版者：Springer Healthcare
• ISSN：2193-6544
• 卷排序：5

文摘

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.