Malignant ventricular arrhythmias induction by programmed electrical stimulation of the right ventricular outflow
N Alessandri1, B L Nguyen, F Tufano
1Department of Cardiology, Polo Pontino, "Sapienza" University of Rome, Rome, Italy. nicola.alessandri@uniroma1.it.
Objective:
The role of electrophysiology study in Brugada syndrome (BS) sudden cardiac death risk stratification remains controversial and seems to depend on the phenotypic expression of the channelopathy. Ajmaline has a key role in the diagnosis of BS. We observed that programmed electrical stimulation (PES) of the right ventricular outflow tract (RVOT), only when type 1 BS ECG is unmasked by ajmaline administration, induces ventricular arrhythmias.
Case Report:
We describe a case of ventricular fibrillation induction by PES of the RVOT when type 1 BS ECG is revealed by ajmaline, in a patient with a baseline dynamic intermittent type 1 and 2 BS ECG.
Conclusions:
The heterogeneous clinical presentations of BS are due to the underlying mechanisms. PES of the RVOT during positive ajmaline test maximizes the channelopathy and therefore sudden cardiac death risk-stratification in BS.
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