Bence Patocskai et al. JACEP 2016;j.jacep

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New interpretation of fractionated electrogram (EG) activity and late potentials. Desynchrony in the appearance of the epicardial action potential second.

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Bence Patocskai et al. JACEP 2016;j.jacep.2016.10.011 Radiofrequency Ablation of Endo Fails to Suppress Brugada Syndrome Phenotype Traces are as described in Figure 1. (A) Control. (B) Recorded 25 min after addition of 8 μM NS5806 and 2 μM verapamil to the coronary perfusate. Homogeneous delay of the second upstroke of the epicardial action potentials gives rise to a late potential on the bipolar electrogram (EG). (C) Recorded 50 min after addition of provocative agents. Concealed phase 2 re-entry gives rise to a high-frequency late potential in the bipolar electrogram. (D) Recorded 10 seconds later. Successful propagation of phase 2 re-entrant extrasystole initiates polymorphic ventricular tachycardia. (E) Recorded 80 min after Endo ablation and withdrawal of the provocative agents. (F) Recorded 25 min after reintroduction of the provocative agents. Endo ablation failed to exert any beneficial effect: the reintroduction of provocative agents induced pronounced Brugada syndrome phenotype with sustained polymorphic tachycardia. Subendo = subendocardium; other abbreviations as in Figure 1. Bence Patocskai et al. JACEP 2016;j.jacep.2016.10.011 American College of Cardiology Foundation