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Endocardial-only catheter ablation with substantial improvement in ventricular fibrillation recurrences in a patient with Brugada syndrome  Tatsuya Hayashi,

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Presentation on theme: "Endocardial-only catheter ablation with substantial improvement in ventricular fibrillation recurrences in a patient with Brugada syndrome  Tatsuya Hayashi,"— Presentation transcript:

1 Endocardial-only catheter ablation with substantial improvement in ventricular fibrillation recurrences in a patient with Brugada syndrome  Tatsuya Hayashi, MD, Junichi Nitta, MD, Masahiko Goya, MD, Mitsuaki Isobe, MD, Kenzo Hirao, MD  HeartRhythm Case Reports  Volume 2, Issue 5, Pages (September 2016) DOI: /j.hrcr Copyright © 2016 Heart Rhythm Society Terms and Conditions

2 Figure 1 A: CARTO mapping in the endocardial right ventricular outflow tract showed low-voltage areas beneath the pulmonary artery valve, with discrete irregularly shaped extensions mostly in the anterior surface, but with some to the lateral and septal sides. B: Electrograms from areas marked a to c in panel A. Fractionated and delayed potentials were observed mostly within the low-voltage area, all of which were targeted as ablation sites. ABL = ablation catheter; AP = anterior-posterior view; d = distal; p = proximal; PA = posterior-anterior view; RV = right ventricle; SPT = sinus of pulmonary trunk. HeartRhythm Case Reports 2016 2, DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

3 Figure 2 All the delayed and fractionated potentials around the right ventricular outflow tract were targeted and ablated. Red tags show ablation points. Application power was limited to 30 W except for some septal sites where it was 35 W, and an SL0 sheath was used to maintain firm contact (A). Typical coved-type electrocardiogram displayed at the beginning of the procedure (Before). ST-segment elevation gradually diminished as ablation proceeded Radio frequency catheter ablation (RFCA #24). We ended the procedure with the disappearance of the coved-type electrocardiographic pattern, the improvement of ST-segment elevation in lead V2, and the cessation of ventricular fibrillation occurrences (Final Application (#59)) (B). AP = anterior-posterior view; PA = posterior-anterior view. HeartRhythm Case Reports 2016 2, DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

4 Figure 3 ST level showed changes with daily variance over the 2 days after the ablation procedure until discharge. Antiarrhythmic drugs were discontinued 14 days after the procedure. Minimum ST level was observed 42 days after the procedure. The coved-type electrocardiographic pattern was not observed during the half year of follow-up. HeartRhythm Case Reports 2016 2, DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

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