title: Malignant ventricular arrhythmias induction by programmed electrical stimulation of the right ventricular outflow tract only during type 1 Brugada ECG maximization.
abstract: The role of electrophysiology study in Brugada syndrome (BS) sudden cardiac death risk stratification remains controversial and seems to depend on the phenotypic expression of the channelopathy. Ajmaline has a key role in the diagnosis of BS. We observed that programmed electrical stimulation (PES) of the right ventricular outflow tract (RVOT), only when type 1 BS ECG is unmasked by ajmaline administration, induces ventricular arrhythmias.
  
  
  
  We describe a case of ventricular fibrillation induction by PES of the RVOT when type 1 BS ECG is revealed by ajmaline, in a patient with a baseline dynamic intermittent type 1 and 2 BS ECG.
  
  
  
  The heterogeneous clinical presentations of BS are due to the underlying mechanisms. PES of the RVOT during positive ajmaline test maximizes the channelopathy and therefore sudden cardiac death risk-stratification in BS.
authors.affiliation: Department of Cardiology, Polo Pontino, "Sapienza" University of Rome, Rome, Italy. nicola.alessandri@uniroma1.it.
authors.forename: N
authors.initials: N
authors.lastname: Alessandri
authors.forename: B L
authors.initials: BL
authors.lastname: Nguyen
authors.forename: F
authors.initials: F
authors.lastname: Tufano
authors.forename: R
authors.initials: R
authors.lastname: Sergiacomi
authors.forename: F
authors.initials: F
authors.lastname: Tersigni
authors.forename: F
authors.initials: F
authors.lastname: Urciuoli
authors.forename: S
authors.initials: S
authors.lastname: De Angelis
authors.forename: A
authors.initials: A
authors.lastname: Dei Giudici
mesh_terms: D000368:Aged; D053840:Brugada Syndrome / Q000175:diagnosis*; D000075224:Cardiac Conduction System Disease; D004558:Electric Stimulation; D004562:Electrocardiography; D006801:Humans; D008297:Male; D014693:Ventricular Fibrillation