Epicardial radiofrequency catheter ablation of Brugada syndrome with electrical storm during ventricular fibrillation

Abstract

Rationale:Brugada syndrome (BrS) is characterized by ST segment elevation at the J point ≥2 mm in the right precordial electrocardiogram (ECG) leads, in the absence of structural heart disease, electrolyte disturbances, or ischemia. It is a well-described cause of sudden death in young patients, especially in the age of between 30 and 40 years old. Here, we reported an unusual case of electrical storm (ES) of ventricular fibrillation (VF) caused by BrS with complete right bundle-branch block (CRBBB) in a 75-year-old male patient.Patient concerns:A 75-year-old male patient survived sudden cardiac death caused by a ventricular ES. He presented with the cove-shaped ST elevation of 2 mm in lead V1 with typical CRBBB and lacked structural cardiomyopathy and coronary heart disease. The patient suffered ventricular ES again, although the implantable cardioverter defibrillator(ICD) had implanted.Diagnoses:Brugada syndrome with complete right bundle-branch block.Interventions:Implantable cardioverter defibrillator (ICD) implantation was performed. But this therapy could not prevent the recurrence of malignant arrhythmia. Finally, the ES was treated successfully using radiofrequency catheter ablation (RFCA) at the area of the free wall of the right ventricular outflow tract (RVOT) epicardium.Outcomes:During 7 months of follow-up, the patient was asymptomatic and free of arrhythmic events.Lessons:As far as we know, the patient is the oldest patient reported to have BrS. RFCA offers an alternative therapy for patients with BrS, especially when ICD shocks are encountered.

Management of patients with an electrical storm or clustered ventricular arrhythmias: a clinical consensus statement of the European Heart Rhythm Association of the ESC—endorsed by the Asia-Pacific Heart Rhythm Society, Heart Rhythm Society, and Latin-American Heart Rhythm Society

“… 49–51 This suggests the presence of subtle subepicardial cardiomyopathy, rather than purely electric disease. 52–56 . Subepicardial conduction in right ventricular outflow tract (RVOT) epicardial regions can be further compromised by impaired Na + current due to the SCN5A pathogenic variant, Na + channel blockade, or pacing, leading to slow/asynchronous conduction, areas of localized block, and creating large potential difference relative to the body of the right ventricle (RV; depolarization theory).…”

Catheter Ablation of Ventricular Fibrillation

“…Multiple case reports have shown successful ablation of PVCs that predominantly originate from the RVOT in BrS [26,[54][55][56]. Hitherto the seminal paper by Nademanee et al, the electroanatomical link between triggering RVOT ectopic beats and the ion channel defects present in BrS remained unclear [57].…”

Multi-disciplinary approach to perioperative risk assessment and post-transplant management for liver transplantation in a patient at risk for Brugada syndrome

“…Quinidine, however, has only proven to be effective in terminating arrhythmias in animal models and small case series (Bozic et al 2018). Radiofrequency catheter ablation has been postulated as a therapeutic approach and has been used in patients who do not respond to pharmacotherapy (Jiang et al 2017).…”