scholarly journals Early Response after Catheter Ablation of the Epicardial Substrate in a Patient with Brugada Syndrome Can Be Predicted by High Precordial Leads

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Yae Min Park ◽  
Mi Sook Cha ◽  
Hanul Choi ◽  
Woong Chol Kang ◽  
Seung Hwan Han ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Brugada Syndrome ◽  
Low Voltage ◽  
Early Stage ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Early Response ◽  
Intercostal Space ◽  
The Right ◽  
Fourth Intercostal Space

A 52-year-old male with Brugada syndrome presented with repeated and appropriate shock from an implantable cardioverter defibrillator (ICD). Catheter ablation for substrate elimination targeting low-voltage, complex, and fractionated electrocardiograms and late potentials in the epicardial right ventricular outflow tract was successfully performed. Brugada phenotype in the right precordial leads from the third intercostal space disappeared in the early stage after catheter ablation and that from the standard fourth intercostal space disappeared later. He remained free from ventricular fibrillation over the next fourteen months. We suggest that this novel ablation strategy is effective in Brugada syndrome patients with ICD, and early response after catheter ablation can be predicted by high precordial leads.

scholarly journals Left Axis Deviation in Brugada Syndrome: Vectorcardiographic Evaluation during Ajmaline Provocation Testing Reveals Additional Depolarization Abnormalities

2021 ◽  
Vol 22 (2) ◽  
pp. 484
Author(s):  
Martijn H. van der Ree ◽  
Jeroen Vendrik ◽  
Jan A. Kors ◽  
Ahmad S. Amin ◽  
Arthur A. M. Wilde ◽  
...  
Keyword(s):  
Sodium Channel ◽  
Brugada Syndrome ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Conduction Delay ◽  
Channel Blockers ◽  
Axis Deviation ◽  
Provocation Testing ◽  
The Right

Patients with Brugada syndrome (BrS) can show a leftward deviation of the frontal QRS-axis upon provocation with sodium channel blockers. The cause of this axis change is unclear. In this study, we aimed to determine (1) the prevalence of this left axis deviation and (2) to evaluate its cause, using the insights that could be derived from vectorcardiograms. Hence, from a large cohort of patients who underwent ajmaline provocation testing (n = 1430), we selected patients in whom a type-1 BrS-ECG was evoked (n = 345). Depolarization and repolarization parameters were analyzed for reconstructed vectorcardiograms and were compared between patients with and without a >30° leftward axis shift. We found (1) that the prevalence of a left axis deviation during provocation testing was 18% and (2) that this left axis deviation was not explained by terminal conduction slowing in the right ventricular outflow tract (4th QRS-loop quartile: +17 ± 14 ms versus +13 ± 15 ms, nonsignificant) but was associated with a more proximal conduction slowing (1st QRS-loop quartile: +12[8;18] ms versus +8[4;12] ms, p < 0.001 and 3rd QRS-loop quartile: +12 ± 10 ms versus +5 ± 7 ms, p < 0.001). There was no important heterogeneity of the action potential morphology (no difference in the ventricular gradient), but a left axis deviation did result in a discordant repolarization (spatial QRS-T angle: 122[59;147]° versus 44[25;91]°, p < 0.001). Thus, although the development of the type-1 BrS-ECG is characterized by a terminal conduction delay in the right ventricle, BrS-patients with a left axis deviation upon sodium channel blocker provocation have an additional proximal conduction slowing, which is associated with a subsequent discordant repolarization. Whether this has implications for risk stratification is still undetermined.

Dormant conduction in the right ventricular outflow tract unmasked by adenosine in a patient with Brugada syndrome

2021 ◽  
Vol 32 (4) ◽  
pp. 1182-1186
Author(s):  
Tsukasa Kamakura ◽  
Josselin Duchateau ◽  
Frédéric Sacher ◽  
Pierre Jais ◽  
Michel Haïssaguerre ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Brugada Syndrome ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Dormant Conduction ◽  
The Right

scholarly journals Gender Differences in Electrophysiological Characteristics of Idiopathic Ventricular Tachycardia Originating From Right Ventricular Outflow Tract

2014 ◽  
pp. S451-S458 ◽  
Author(s):  
S.-G. YANG ◽  
M. MLČEK ◽  
O. KITTNAR
Keyword(s):  
Gender Differences ◽  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Right Ventricular ◽  
Low Voltage ◽  
Treatment Strategies ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Idiopathic Ventricular Tachycardia

It has become increasingly apparent in recent years that there are important differences of many cardiovascular disorders including ventricular tachycardias in men and women. Nevertheless, so far just few studies have addressed possible gender differences in electrophysiological characteristics of idiopathic ventricular tachycardia from right ventricular outflow tract (RVOT-VT), other than epidemiological ones. This study explored possible gender differences in electrophysiological characteristics and catheter ablation outcome in RVOT-VT patients. Ninety-three patients (mean age 38.7±15.5 years, 30 males) with idiopathic RVOT-VT were enrolled and analyzed in our study. Male patients had longer QRS width (99.9±19.4 ms vs. 88.4±20.7 ms, p=0.02). Female patients had lower right ventricular mean voltage (3.0±0.7 mV vs. 3.7±0.9 mV, p=0.03), and more low voltage zone over the right ventricular outflow tract free wall (27.0 % vs. 6.7 %, p=0.02). Eighty-one patients passed catheter ablation (23 males). The acute success rate, repeated catheter ablation rate and VT recurrence rate were similar in both genders. The present study provides evidence of the gender differences in electrophysiological findings in patients with idiopathic RVOT-VT. Studies on gender-specific differences in arrhythmia could lead to a better understanding of its mechanism(s) and provide valuable information for the development of optimal treatment strategies.

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