title: Combined Right Ventricular Outflow Tract Epicardial and Endocardial Late Potential Ablation for Treatment of Brugada Storm: A Case Report and Review of the Literature.
abstract: A 34-year-old man with Brugada syndrome (BrS) presented with electrical storm, manifested as multiple appropriate shocks from his implantable cardioverter-defibrillator over a period of 7 hours. He had not tolerated prior treatment with quinidine, and had self-discontinued cilostazol citing persistent palpitations. After stabilization with intravenous isoproterenol, an electrophysiology study was performed but no spontaneous or induced ventricular ectopic beats were identified. A three-dimensional (3D) endocardial electro-anatomic map of the right ventricular outflow tract (RVOT), pulmonic valve, and pulmonary artery, as well as a 3D epicardial map of the RVOT, were created. Low voltage, complex, fractionated electrograms and late potentials were targeted for irrigated radiofrequency ablation both endocardially and epicardially. Post-procedure, he was maintained on cilostazol (referring clinician preference), and has had no further ventricular tachyarrhythmia episodes over the past forty-one months. We propose that this novel ablation strategy may be useful for acute management of selected patients with BrS.
authors.affiliation: Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA. sandeep_a_saha@rush.edu.
authors.forename: Sandeep A
authors.initials: SA
authors.lastname: Saha
authors.affiliation: Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Kousik
authors.initials: K
authors.lastname: Krishnan
authors.affiliation: Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Madias
authors.affiliation: Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Trohman
keywords: Brugada syndrome; Implantable cardioverter-defibrillator; Late potentials; Radiofrequency ablation