Catheter Ablation for Brugada Syndrome

Area of Science:

• Cardiac Electrophysiology
• Interventional Cardiology

Background:

• Brugada syndrome is a genetic disorder characterized by abnormal electrocardiogram (ECG) findings and an increased risk of sudden cardiac death.
• Refractory ventricular fibrillation (VF) in Brugada syndrome poses a significant clinical challenge, often inadequately managed by standard therapies like quinidine.

Observation:

• Epicardial substrate mapping in a patient with refractory VF due to Brugada syndrome revealed abnormal, fractionated, and prolonged electrograms in the anterior right ventricular outflow tract.
• Pericardial warm saline infusion exacerbated local electrogram delays, confirming the substrate's link to Brugada syndrome pathophysiology.
• Coronary angiography excluded major coronary artery involvement in the identified ablation target area.

Findings:

• Catheter ablation targeting the epicardial substrate in the right ventricular outflow tract successfully eliminated local abnormal electrograms.
• Post-ablation, the characteristic coved-type ST elevation in leads V1-V2 resolved, indicating normalization of the ECG phenotype.
• The patient remained free of ventricular fibrillation recurrence at a five-month follow-up, demonstrating the efficacy of the ablation procedure.

Implications:

• Epicardial catheter ablation is a viable therapeutic option for select Brugada syndrome patients with refractory ventricular arrhythmias.
• Substrate mapping can precisely identify arrhythmogenic substrates in the right ventricular outflow tract for targeted ablation.
• This approach offers a potential strategy to prevent sudden cardiac death in high-risk Brugada syndrome patients unresponsive to medical therapy.