Combined Right Ventricular Outflow Tract Epicardial and Endocardial Late Potential Ablation for Treatment of Brugada Storm: A Case Report and Review of the Literature. Issue 2 (December 2016)

• Record Type: Journal Article
• Authors: Saha, Sandeep; Krishnan, Kousik; Madias, Christopher; Trohman, Richard
• Is Part Of: Cardiology and therapy. Volume 5:Issue 2(2016)
• Page Start: 229
• Page End: 243
• Publication Date: 2016-12
• Subjects: Brugada syndrome -- Implantable cardioverter-defibrillator -- Late potentials -- Radiofrequency ablation; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Treatment -- Periodicals; Cardiovascular Diseases -- Periodicals; 616.12005
• DOI: 10.1007/s40119-016-0072-4
• Languages: English
• ISSNs: 2193-8261

Abstract

Abstract 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.