Radiofrequency Ablation of Ventricular Fibrillation and Multiple Right and Left Atrial Tachycardia in a Patient with Brugada Syndrome

Abstract

Brugada syndrome is a well-known form of idiopathic ventricular fibrillation (VF). Few data suggest that this arrhythmia may be triggered by ventricular premature beats (VPBs), and an association with other arrhythmia such as monomorphic ventricular tachycardia (VT) or supraventricular tachycardia (SVT) has been reported. In a highly symptomatic 18-year-old-male patient with this syndrome, frequent episodes of VF, fast polymorphic VT, and fast monomorphic sustained regular tachycardia were observed. The tachycardia episodes were classified as VT or VF and as a consequence received appropriate therapies with the implanted cardioverter defibrillator (ICD). Precipitating VPBs that were stored in the ICD memory and on the electrocardiogram (ECG) exhibited the same morphology as frequent isolated VPBs. During the electrophysiological study, right and left atrial tachycardia (AT) with one-to-one atrioventricular conduction were also induced and successfully ablated. VF was ablated using the same noncontact mapping (NCM) system triggering VPBs from right ventricular outflow tract (RVOT).

Successful Radiofrequency Catheter Ablation for Electrical Storm of Ventricular Fibrillation in a Patient With Brugada Syndrome

“…Darmon et al reported one symptomatic patient in whom catheter ablation for triggering PVCs and 2 other types of PVCs originating from the RVOT area resulted in suppression of VF for 6 months. 6 In the present case, we found that the VF-triggering PVCs originated from the posterior portion of the RVOT lateral wall. Despite the remaining PVCs originating from the RVOT and RV inflow tract areas, successful catheter ablation for the VF-triggering PVCs prevented the recurrence of VF for 29 months, the longest event-free period yet reported.…”

“…5,6,15 These reports showed that the QRS morphology of the first beat of VF episodes was identical to that of the PVCs recorded before such episodes occurred. 5,6,10 Haïssaguerre et al reported successful catheter ablation for triggering PVCs for treatment of recurrence of VF in 3 symptomatic patients with BS.…”

“…5,6,15 These reports showed that the QRS morphology of the first beat of VF episodes was identical to that of the PVCs recorded before such episodes occurred. 5,6,10 Haïssaguerre et al reported successful catheter ablation for triggering PVCs for treatment of recurrence of VF in 3 symptomatic patients with BS. 5 Two of the patients in their study had triggering PVCs with left bundle-branch block morphology and inferior axis originating from the RVOT area, and the other had triggering PVCs with left bundle-branch block morphology and superior axis originating from the anterior RV Purkinje network.…”

Catheter Ablation of Polymorphic Ventricular Tachycardia and Ventricular Fibrillation

“…The first report on CA of a triggering focus of polymorphic VT or VF was presented again by Haïssaguerre et al 19 Subsequently, other anecdotal cases were published on successful ablation of triggering ectopy within the right ventricular outflow tract sites in patients with this condition. 22,23 More interestingly, other authors explored the possibility of modifying a substrate for VF in patients with Brugada syndrome. The first prospective study of VF ablation in Brugada syndrome patients was reported by Nademanee et al 13 This group evaluated nine patients (all male; median age 38 years) with recurrent VF that required multiple ICD A similar finding was described by the Bordeaux group in a case report 24 and confirms previous pilot experimental evidence.…”

Brugada Syndrome

“…The initial approach was designed to target the initiating PVCs that trigger VF, which were found to come from the RVOT. 101- 103 The ablation was performed on the endocardial site of the RVOT. However, this approach has not been widely successful, largely because patients with BS rarely had PVCs frequently enough to be mapped and therefore it was quite difficult to identify the precise targets for ablation and clearly VEERAKUL G et al…”