Coved-type ST-elevation during ablation of ischemic ventricular tachycardia

Area of Science:

• Cardiology
• Electrophysiology
• Medical Diagnostics

Background:

• Brugada syndrome is characterized by coved-type electrocardiogram (ECG) changes, often attributed to delayed right ventricular outflow tract depolarization.
• Coronary artery ischemia, specifically of the right coronary artery's conus branch, can also manifest with similar coved-type ECG changes.
• Distinguishing between these causes is critical for accurate diagnosis and management.

Purpose of the Study:

• To report a case of transient coved-type ECG changes during ventricular tachycardia catheter ablation.
• To discuss the differential diagnosis of coved-type ECG changes in the context of cardiac procedures.

Main Methods:

• Case report of a 63-year-old male with myocardial infarction history undergoing catheter ablation.
• Observation of transient coved-type ECG changes during left ventricular mapping.
• Performance of a pilsicainide challenge test post-procedure.

Main Results:

• A transient coved-type ECG change occurred during left ventricular mapping in a patient undergoing ventricular tachycardia ablation.
• The ECG abnormality resolved spontaneously without any associated chest symptoms.
• A subsequent pilsicainide test was negative, and no coved-type ECG changes were observed perioperatively or during follow-up.

Conclusions:

• Transient coved-type ECG changes during procedures like catheter ablation can mimic Brugada syndrome.
• Ischemia or other transient phenomena should be considered in the differential diagnosis, especially when Brugada syndrome is not clinically suspected.
• Negative pharmacological challenge tests and absence of recurrence support a non-Brugada syndrome etiology in this case.