Hybrid thoracoscopic epicardial ablation of right ventricular outflow tract in patients with Brugada syndrome

Hybrid Surgical Ablation of Recurrent Ventricular Tachycardia in a Patient With High-Risk Brugada Syndrome

“…Therefore, the strategy of epicardial surgical RVOT ablation was used after the recurrence, using a hybrid cardiac surgery ablation approach to overcome the potential limitations of percutaneous ablation. This technique has been developed in our center, was first described by Salghetti et al, 10 and allows direct visualization of the target region and a clear view of the surrounding anatomical structures, which makes this procedure safe as effective. The real-time monitoring of probe contact and using specific tools designed especially for VAT procedures allows the creation of wider and durable lesions with less edema and a shorter procedure time.…”

“…The real-time monitoring of probe contact and using specific tools designed especially for VAT procedures allows the creation of wider and durable lesions with less edema and a shorter procedure time. 10 …”

Concomitant thoracoscopic left cardiac sympathectomy and RVOT epicardial ablation of the arrhythmogenic substrate in a patient with Long QT and Brugada syndromes related to uncommon sodium channel beta‐subunit mutation

“…A diagnosis of likely LQTS syndrome was made according to the Scwhartz and Crotti criteria (score 3,5) 7 . An ajmaline test was conducted using an infusion protocol of 1 mg/kg in 5 min 8 ; positivity to Brugada syndrome was defined as an elevation of the J point ≥ 2 mm in V1 and/or V2 leads. The ajmaline test resulted positive for a Brugada type 1 pattern at 1 mg/kg dose (Figure S2).…”

“…The procedure was performed under general anesthesia with the EnSite Precision mapping system (Abbott, Chicago, IL, USA) and the noninvasive CardioInsight mapping vest (Medtronic, Minneapolis, MN, USA). A left thoracoscopic access was obtained as previously described 8 …”

“…The map showed a small area of abnormal electrograms (AEMs) in the RVOT, close to the pulmonary valve (Figure S4 ). AEMs were defined by at least one of these characteristics: low voltage (≤1 mV) signals, prolonged (> 80 ms) and fragmented signals (≥2 distinct peaks) and/or late potentials 8 . A protocol of ajmaline infusion (1 mg/kg in 5 min) was then started resulting in appearance of complete RBBB at the end of infusion.…”