title: Endocardial mapping and catheter ablation for ventricular fibrillation prevention in Brugada syndrome.
abstract: Endocardial Mapping and Ablation of Brugada Syndrome.
  
  
  BACKGROUND
  Brugada syndrome (BS) is characterized by ST-segment elevation in the right precordial electrocardiogram (ECG) leads and episodes of ventricular fibrillation (VF). This study aimed to observe the feasibility of substrate modification by radiofrequency catheter ablation and its effects on VF storm.
  
  
  RESULTS
  Ten BS patients (all men; median age 36.5 years) with VF storm (group I, n = 4) and no VF storm (group II, n = 6) were enrolled in the study between August 2007 and December 2008. All patients underwent electrophysiological study using noncontact mapping. The multielectrode array was placed in the right ventricular outflow tract (RVOT). The isopotential map was analyzed during sinus rhythm and the region that had electrical activity occurring during J point to +60 (J+60) milliseconds interval of the V1 or V2 of surface ECG was considered as the late activation zone (LAZ) and also the substrate for ablation. LAZ was found in RVOT with variable distribution in both groups. Endocardial catheter ablation of the LAZ modified Brugada ECG pattern in 3 of 4 patients (75%) and suppressed VF storm in all 4 patients in group I during long-term follow-up (12-30 months). One patient had complete right bundle branch block from the ablation procedure.
  
  
  CONCLUSIONS
  LAZ on RVOT identified by noncontact mapping may serve as potential VF substrate in BS patients with VF episodes. Radiofrequency ablation on LAZ normalized ECG, suppressed VF storm, and reduced VF recurrence. The procedure is safe and may prevent VF occurrence.
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, Cardiac Center, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Buncha
authors.initials: B
authors.lastname: Sunsaneewitayakul
authors.forename: Yan
authors.initials: Y
authors.lastname: Yao
authors.forename: Suthasinee
authors.initials: S
authors.lastname: Thamaree
authors.forename: Shu
authors.initials: S
authors.lastname: Zhang
mesh_terms: D000200:Action Potentials; D000328:Adult; D053840:Brugada Syndrome / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D002037:Bundle-Branch Block / Q000209:etiology; D017115:Catheter Ablation / Q000009:adverse effects; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D004699:Endocardium / Q000503:physiopathology*; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult