title: Epicardial ablation for prevention of ventricular fibrillation in a patient with Brugada syndrome.
abstract: We present the case of a 60-year-old woman with Brugada syndrome, permanent type 1 electrocardiographic pattern, who had previously received an implantable cardioverter-defibrillator. She suffered frequent syncopal episodes and multiple appropriate shocks (around five per month) due to polymorphic ventricular tachycardia/ventricular fibrillation, refractory to quinidine therapy. Combined epicardial and endocardial electroanatomical mapping was performed with a view to substrate ablation. An area of abnormal fractionated electrograms, lasting up to 370 ms and up to 216 ms after the end of the surface QRS, was identified in the epicardium in the lower anterior part of the right ventricular outflow tract. Extensive epicardial ablation of this area, which eliminated the fractionated electrograms, led to the disappearance of the Brugada electrocardiographic pattern six weeks after ablation. Despite discontinuation of quinidine, no further ventricular arrhythmias occurred during follow-up, which is still of short duration.
authors.affiliation: Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Cardiologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal. Electronic address: cortezdias@yahoo.com.
authors.forename: Nuno
authors.initials: N
authors.lastname: Cortez-Dias
authors.affiliation: Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Cardiologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Plácido
authors.affiliation: Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Serviço de Cardiologia, Hospital Distrital de Santarém, Santarém, Portugal.
authors.forename: Liliana
authors.initials: L
authors.lastname: Marta
authors.affiliation: Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Bernardes
authors.affiliation: Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal.
authors.forename: Sílvia
authors.initials: S
authors.lastname: Sobral
authors.affiliation: Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Cardiologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Carpinteiro
authors.affiliation: Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Cardiologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: de Sousa
mesh_terms: D053840:Brugada Syndrome / Q000150:complications*; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D008875:Middle Aged; D010496:Pericardium; D014693:Ventricular Fibrillation / Q000209:etiology* / Q000517:prevention & control*
keywords: Ablação epicárdica; Ablação por cateter; Brugada syndrome; Catheter ablation; Electrophysiology; Eletrofisiologia; Epicardial ablation; Mapeamento; Mapping; Síndrome de Brugada