PMC5949194_01
ECG after stabilization showed sinus rhythm with type I Brugada pattern, resulting in the diagnosis of Brugada syndrome. ECG = electrocardiogram.
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ECG after stabilization showed sinus rhythm with type I Brugada pattern (Figure 1). Echocardiography demonstrated no structural heart disease with normal left ventricular ejection fraction, and cardiac magnetic resonance imaging scan demonstrated normal biventricular function with no late gadolinium enhancement.
(a) Epicardial mapping revealed an extensive area of low voltage with fragmented and late potential in the anterior RVOT. Gray color of 3D mapping indicates scar tissue, and these areas were measured at 34.4 mm2, with the longest total duration of abnormal fractionated potential up to 468 ms and up to 326 ms after the end of the surface QRS. (b) Epicardial ablation was performed targeting the area of low voltage with fragmented and late potential in the anterior epicardial RVOT. (c) Remapped epicardial voltage mapping revealed that these areas were substituted with a scar. RVOT = right ventricular outflow tract.
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Unipolar mapping showed J-point elevation identical to the typical Brugada pattern (Figure 2(a)). Jude Medical, Minnetonka, MN, USA) targeting these areas (35 W; total ablation time: 19.8 minutes) (Figure 2(b)). Remapped epicardial voltage mapping revealed that these areas were replaced with scar tissue (<0.1 mV; Figure 2(c)).
ECGs of the Brugada syndrome patient showing recordings of the anterior precordial leads: V1-2 leads from the 4th intercostal space and high precordial leads (V5 and V6 positioned cranially from V1 and V2) from the 3rd intercostal space. (a) Baseline before catheter ablation; (b) three days after ablation; (c) one month after ablation. Note the disappearance of the Brugada pattern at high precordial leads (V5-6) in the early stage and then at standard precordial V1-2 leads after catheter ablation. (d) The flecainide provocative test after three months of ablation revealed unmasking of type I Brugada pattern. ECG = electrocardiogram.
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One month later, the Brugada pattern of precordial leads from either the third or fourth intercostal space disappeared (Figures 3(a)-3(c)). The flecainide provocative test (2 mg/kg for 10 minutes) was performed after three months of catheter ablation which revealed unmasking of type I Brugada pattern (Figure 3(d)).