1
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Estrada-Magana A, Hernández JJ, Totomoch-Serra A, González-Pacheco H, Márquez MF. A representative case of quinidine's therapeutic effect on Brugada syndrome and the negative impact of the lack of availability in some countries, with a brief note on the lack of benefit of cilostazol. HeartRhythm Case Rep 2024; 10:259-262. [PMID: 38766620 PMCID: PMC11096427 DOI: 10.1016/j.hrcr.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Affiliation(s)
- Andres Estrada-Magana
- Department of Electrocardiology and Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City, Mexico
| | - Jhonatan J. Hernández
- Department of Electrocardiology and Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City, Mexico
| | - Armando Totomoch-Serra
- Department of Electrocardiology and Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City, Mexico
| | - Héctor González-Pacheco
- Department of Electrocardiology and Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City, Mexico
| | - Manlio F. Márquez
- Department of Electrocardiology and Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City, Mexico
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2
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Kotake Y, Barua S, Kazi S, Virk S, Bhaskaran A, Campbell T, Bennett RG, Kumar S. Efficacy and safety of catheter ablation for Brugada syndrome: an updated systematic review. Clin Res Cardiol 2023; 112:1715-1726. [PMID: 35451610 PMCID: PMC10698106 DOI: 10.1007/s00392-022-02020-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/31/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Patients with Brugada syndrome (BrS) may experience recurrent ventricular arrhythmias (VAs). Catheter ablation is becoming an emerging paradigm for treatment of BrS. OBJECTIVE To assess the efficacy and safety of catheter ablation in BrS in an updated systematic review. METHODS We comprehensively searched the databases of Pubmed/Medline, EMBASE, and Cochrane Central Register of Controlled Trials from inception to 11th of August 2021. RESULTS Fifty-six studies involving 388 patients were included. A substrate-based strategy was used in 338 cases (87%), and a strategy of targeting premature ventricular complex (PVCs)/ventricular tachycardias (VTs) that triggered ventricular fibrillation (VF) in 47 cases (12%), with combined abnormal electrogram and PVC/VT ablation in 3 cases (1%). Sodium channel blocker was frequently used to augment the arrhythmogenic substrate in 309/388 cases (80%), which included a variety of agents, of which ajmaline was most commonly used. After ablation procedure, the pooled incidence of non-inducibility of VA was 87.1% (95% confidence interval [CI], 73.4-94.3; I2 = 51%), and acute resolution of type I ECG was seen in 74.5% (95% CI [52.3-88.6]; I2 = 75%). Over a weighted mean follow up of 28 months, 7.6% (95% CI [2.1-24]; I2 = 67%) had recurrence of type I ECG either spontaneously or with drug challenge and 17.6% (95% CI [10.2-28.6]; I2 = 60%) had recurrence of VA. CONCLUSION Catheter ablation appears to be an efficacious strategy for elimination of arrhythmias or substrate associated with BrS. Further study is needed to identify which patients stand to benefit, and optimal provocation protocol for identifying ablation targets.
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Affiliation(s)
- Yasuhito Kotake
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Westmead, NSW, Australia
| | - Sumita Barua
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
| | - Samia Kazi
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
| | - Sohaib Virk
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
| | - Ashwin Bhaskaran
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Westmead, NSW, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Westmead, NSW, Australia
| | - Richard G Bennett
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Westmead, NSW, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia.
- Westmead Applied Research Centre, University of Sydney, Westmead, NSW, Australia.
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3
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Sáenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace 2020; 21:1143-1144. [PMID: 31075787 DOI: 10.1093/europace/euz132] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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4
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Bella PD, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Interv Card Electrophysiol 2020; 59:145-298. [PMID: 31984466 PMCID: PMC7223859 DOI: 10.1007/s10840-019-00663-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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5
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Kim Y, Chen S, Ernst S, Guzman CE, Han S, Kalarus Z, Labadet C, Lin Y, Lo L, Nogami A, Saad EB, Sapp J, Sticherling C, Tilz R, Tung R, Kim YG, Stiles MK. 2019 APHRS expert consensus statement on three-dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS. J Arrhythm 2020; 36:215-270. [PMID: 32256872 PMCID: PMC7132207 DOI: 10.1002/joa3.12308] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/20/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Young‐Hoon Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
| | - Shih‐Ann Chen
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Sabine Ernst
- Department of CardiologyRoyal Brompton and Harefield HospitalImperial College LondonLondonUK
| | | | - Seongwook Han
- Division of CardiologyDepartment of Internal MedicineKeimyung University School of MedicineDaeguRepublic of Korea
| | - Zbigniew Kalarus
- Department of CardiologyMedical University of SilesiaKatowicePoland
| | - Carlos Labadet
- Cardiology DepartmentArrhythmias and Electrophysiology ServiceClinica y Maternidad Suizo ArgentinaBuenos AiresArgentina
| | - Yenn‐Jian Lin
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Li‐Wei Lo
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Akihiko Nogami
- Department of CardiologyFaculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Eduardo B. Saad
- Center for Atrial FibrillationHospital Pro‐CardiacoRio de JaneiroBrazil
| | - John Sapp
- Division of CardiologyDepartment of MedicineQEII Health Sciences CentreDalhousie UniversityHalifaxNSCanada
| | | | - Roland Tilz
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine)University Hospital Schleswig‐Holstein (UKSH) – Campus LuebeckLuebeckGermany
| | - Roderick Tung
- Center for Arrhythmia CarePritzker School of MedicineUniversity of Chicago MedicineChicagoILUSA
| | - Yun Gi Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
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6
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Rizzo A, de Asmundis C, Brugada P, La Meir M, Chierchia GB. Ablation for the treatment of Brugada syndrome: current status and future prospects. Expert Rev Med Devices 2020; 17:123-130. [PMID: 31986921 DOI: 10.1080/17434440.2020.1719831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Brugada syndrome (BrS) is an inherited disease characterized by an increased risk of sudden cardiac death (SCD). Therapeutic options in symptomatic patients are limited to implantable cardioverter defibrillator (ICD) and quinidine, but catheter ablation of the right ventricular outflow tract (RVOT) offers a potential cure. Different ablation strategies have been used to treat patients with symptomatic Brugada syndrome. Epicardial radiofrequency substrate ablation of the RVOT/right ventricle (RV) has emerged as a promising tool for the management of the disease.Areas covered: The historical management of BrS, endocardial and epicardial ablation techniques, the use of sodium channel blockers (SCB) and complications are summarized here.Expert opinion: Ventricular fibrillation (VF)-triggering premature ventricular contractions (PVCs) in patients with BrS are unpredictable, spontaneous ones are rarely present to be mapped, making this approach impractical. Furthermore, endocardial mapping for BrS substrates does not seem effective due to the epicardial pathological substrate localization. The size variation of the BrS substrate areas during SCB infusion suggests a dynamic process as arrhythmogenic basis and SCB infusion should guide BrS epicardial ablation of all abnormal potentials areas. If BrS epicardial ablation can truly provide long-term prevention of ventricular arrhythmias it may potentially become an alternative to ICD therapy.
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Affiliation(s)
- Alessandro Rizzo
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Mark La Meir
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
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7
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Talib AK, Nogami A. Catheter Ablation for Brugada Syndrome. Korean Circ J 2020; 50:289-301. [PMID: 31960637 PMCID: PMC7067603 DOI: 10.4070/kcj.2019.0344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/03/2019] [Indexed: 11/11/2022] Open
Abstract
Brugada syndrome (BrS) is an arrhythmogenic disease associated with an increased risk of ventricular fibrillation (VF) and sudden cardiac death (SCD). To date, the standard therapy for the prevention of SCD in BrS is the use of an implantable cardioverter-defibrillator (ICD) especially in patients who have experienced a prior cardiac arrest or syncopal events secondary to VF. However, ICDs do not prevent the occurrence of VF but react to defibrillate the VF episode, thereby preventing SCD. Often patients with recurrent VF have to be maintained on antiarrhythmic drugs that are effective but have remarkable adverse effects. An alternative therapy for BrS with recurrent VF is catheter ablation which emerged as an effective therapy in eliminating VF-triggering premature ventricular complexes in limited case series; however, there has been a remarkable progress in effectiveness of catheter ablation since epicardial substrate ablation was first applied in 2011 and such approach is now widely applicable.
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Affiliation(s)
- Ahmed Karim Talib
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Division of Cardiac Electrophysiology, Al Najaf Center for Cardiac Surgery and Trans-Catheter Therapy, Najaf, Iraq
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
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8
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Coppola G, Corrado E, Curnis A, Maglia G, Oriente D, Mignano A, Brugada P. Update on Brugada Syndrome 2019. Curr Probl Cardiol 2019; 46:100454. [PMID: 31522883 DOI: 10.1016/j.cpcardiol.2019.100454] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/29/2019] [Indexed: 12/15/2022]
Abstract
Brugada syndrome (BrS) was first described in 1992 as an aberrant pattern of ST segment elevation in right precordial leads with a high incidence of sudden cardiac death (SCD) in patients with structurally normal heart. It represents 4% ∼ 12% of all SCD and 20% of SCD in patients with structurally normal heart. The extremely wide genetic heterogeneity of BrS and other inherited cardiac disorders makes this new area of genetic arrhytmology a fascinating one. This review shows the state of art in diagnosis, management, and treatment of BrS focusing all the aspects regarding genetics and Preimplant Genetic Diagnosis (PGD) of embryos, overlapping syndromes, risk stratification, familial screening, and future perspectives. Moreover the review analyzes key points like electrocardiogram (ECG) criteria, the role of electrophysiological study (the role of ventricular programmed stimulation and the need of universal accepted protocol) and the importance of a correct risk stratification to clarify when implantable cardioverter defibrillator or a close follow-up is needed. In recent years, cardiovascular studies have been focused on personalized risk assessment and to determine the most optimal therapy for an individual. The BrS syndrome has also benefited of these advances although there remain several key points to be elucidated. We will review the present knowledge, progress made, and future research directions on BrS.
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9
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm 2019; 17:e2-e154. [PMID: 31085023 PMCID: PMC8453449 DOI: 10.1016/j.hrthm.2019.03.002] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 01/10/2023]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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10
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Nakagawa E, Naruko T, Makita T. Reproducibility and diagnostic usefulness of repeated sodium channel blocker test at higher precordial electrocardiogram recording in a patient with Brugada syndrome. HeartRhythm Case Rep 2019; 5:251-255. [PMID: 31193222 PMCID: PMC6522474 DOI: 10.1016/j.hrcr.2019.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Eiichiro Nakagawa
- Division of Cardiac Electrophysiology, Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Toshinori Makita
- Division of Cardiac Electrophysiology, Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
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11
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Anderson RD, Kumar S, Kalman JM, Sanders P, Sacher F, Hocini M, Jais P, Haïsaguerre M, Lee G. Catheter Ablation of Ventricular Fibrillation. Heart Lung Circ 2019; 28:110-122. [DOI: 10.1016/j.hlc.2018.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/29/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
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12
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Ablation strategies for the management of symptomatic Brugada syndrome: A systematic review. Heart Rhythm 2018; 15:1140-1147. [DOI: 10.1016/j.hrthm.2018.03.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Indexed: 11/18/2022]
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13
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Talib AK, Takagi M, Shimane A, Nakano M, Hayashi T, Okajima K, Kentaro M, Fukada K, Kowase S, Kurosaki K, Nitta J, Nishizaki M, Yui Y, Talib A, Sato N, Kawamura Y, Hasebe N, Aita S, Sai E, Komatsu Y, Kuroki K, Kaneshiro T, Dongzu X, Tajiri K, Igarashi M, Yamasaki H, Murakoshi N, Kumagai K, Sekiguchi Y, Nogami A, Aonuma K. Efficacy of Endocardial Ablation of Drug-Resistant Ventricular Fibrillation in Brugada Syndrome. Circ Arrhythm Electrophysiol 2018; 11:e005631. [DOI: 10.1161/circep.117.005631] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ahmed Karim Talib
- Cardiovascular Division, Faculty of Medicine, Tsukuba University, Ibaraki, Japan (A.K.T., S.A., E.S., Y.K., K.K., T.K., X.D., K.T., M.I., H.Y., N.M., Y.S., A.N., K.A.)
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Cardiovascular Center, Kansai Medical University Medical Center, Osaka, Japan (M.T.)
| | - Akira Shimane
- Cardiovascular Division, Faculty of Medicine, Tsukuba University, Ibaraki, Japan (A.K.T., S.A., E.S., Y.K., K.K., T.K., X.D., K.T., M.I., H.Y., N.M., Y.S., A.N., K.A.)
- Himeji Cardiovascular Center, Japan (A.S., K.O.)
| | - Makoto Nakano
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Japan (M.N.)
| | - Tatsuya Hayashi
- Cardiovascular Division, Saitama Red Cross Hospital, Japan (T.H., J.N.)
| | | | - Minami Kentaro
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (M.K., K.K.)
| | - Koji Fukada
- Tohoku University Graduate School of Medicine, Sendai, Japan (M.N., K.F.)
| | - Shinya Kowase
- Department of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama (S.K., K.K.)
| | | | - Junichi Nitta
- Cardiovascular Division, Saitama Red Cross Hospital, Japan (T.H., J.N.)
| | | | - Yoshiaki Yui
- Cardiology Department, Tokyo Metropolitan Bokutoh Hospital, Japan (Y.Y.)
| | - Ali Talib
- Department of Cardiology, Asahikawa Medical University, Hokkaido, Japan (A.T., N.S., Y.K., N.H.)
| | - Nobuyuki Sato
- Department of Cardiology, Asahikawa Medical University, Hokkaido, Japan (A.T., N.S., Y.K., N.H.)
| | - Yuichiro Kawamura
- Department of Cardiology, Asahikawa Medical University, Hokkaido, Japan (A.T., N.S., Y.K., N.H.)
| | - Naoyuki Hasebe
- Department of Cardiology, Asahikawa Medical University, Hokkaido, Japan (A.T., N.S., Y.K., N.H.)
| | | | - Eikou Sai
- Cardiovascular Division, Faculty of Medicine, Tsukuba University, Ibaraki, Japan (A.K.T., S.A., E.S., Y.K., K.K., T.K., X.D., K.T., M.I., H.Y., N.M., Y.S., A.N., K.A.)
| | - Yuki Komatsu
- Cardiovascular Division, Faculty of Medicine, Tsukuba University, Ibaraki, Japan (A.K.T., S.A., E.S., Y.K., K.K., T.K., X.D., K.T., M.I., H.Y., N.M., Y.S., A.N., K.A.)
| | - Kenji Kuroki
- Cardiovascular Division, Faculty of Medicine, Tsukuba University, Ibaraki, Japan (A.K.T., S.A., E.S., Y.K., K.K., T.K., X.D., K.T., M.I., H.Y., N.M., Y.S., A.N., K.A.)
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (M.K., K.K.)
- Department of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama (S.K., K.K.)
| | - Takashi Kaneshiro
- Cardiovascular Division, Faculty of Medicine, Tsukuba University, Ibaraki, Japan (A.K.T., S.A., E.S., Y.K., K.K., T.K., X.D., K.T., M.I., H.Y., N.M., Y.S., A.N., K.A.)
| | - Xu Dongzu
- Cardiovascular Division, Faculty of Medicine, Tsukuba University, Ibaraki, Japan (A.K.T., S.A., E.S., Y.K., K.K., T.K., X.D., K.T., M.I., H.Y., N.M., Y.S., A.N., K.A.)
| | - Kazuko Tajiri
- Cardiovascular Division, Faculty of Medicine, Tsukuba University, Ibaraki, Japan (A.K.T., S.A., E.S., Y.K., K.K., T.K., X.D., K.T., M.I., H.Y., N.M., Y.S., A.N., K.A.)
| | - Miyako Igarashi
- Cardiovascular Division, Faculty of Medicine, Tsukuba University, Ibaraki, Japan (A.K.T., S.A., E.S., Y.K., K.K., T.K., X.D., K.T., M.I., H.Y., N.M., Y.S., A.N., K.A.)
| | - Hiro Yamasaki
- Cardiovascular Division, Faculty of Medicine, Tsukuba University, Ibaraki, Japan (A.K.T., S.A., E.S., Y.K., K.K., T.K., X.D., K.T., M.I., H.Y., N.M., Y.S., A.N., K.A.)
| | - Nobuyuki Murakoshi
- Cardiovascular Division, Faculty of Medicine, Tsukuba University, Ibaraki, Japan (A.K.T., S.A., E.S., Y.K., K.K., T.K., X.D., K.T., M.I., H.Y., N.M., Y.S., A.N., K.A.)
| | - Koji Kumagai
- Cardiovascular Division, Faculty of Medicine, Tsukuba University, Ibaraki, Japan (A.K.T., S.A., E.S., Y.K., K.K., T.K., X.D., K.T., M.I., H.Y., N.M., Y.S., A.N., K.A.)
| | - Yukio Sekiguchi
- Cardiovascular Division, Faculty of Medicine, Tsukuba University, Ibaraki, Japan (A.K.T., S.A., E.S., Y.K., K.K., T.K., X.D., K.T., M.I., H.Y., N.M., Y.S., A.N., K.A.)
| | - Akihiko Nogami
- Cardiovascular Division, Faculty of Medicine, Tsukuba University, Ibaraki, Japan (A.K.T., S.A., E.S., Y.K., K.K., T.K., X.D., K.T., M.I., H.Y., N.M., Y.S., A.N., K.A.)
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, Tsukuba University, Ibaraki, Japan (A.K.T., S.A., E.S., Y.K., K.K., T.K., X.D., K.T., M.I., H.Y., N.M., Y.S., A.N., K.A.)
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Abstract
INTRODUCTION Brugada syndrome (BrS) is an inherited cardiac arrhythmia syndrome characterized by ST-segment elevation in right precordial ECG leads and associated with sudden cardiac death in young adults. The ECG manifestations of BrS are often concealed but can be unmasked by sodium channel blockers and fever. Areas covered: Implantation of a cardioverter defibrillator (ICD) is first-line therapy for BrS patients presenting with prior cardiac arrest or documented VT. A pharmacological approach to therapy is recommended in cases of electrical storm, as an adjunct to ICD and as preventative therapy. The goal of pharmacological therapy is to produce an inward shift to counter the genetically-induced outward shift of ion channel current flowing during the early phases of the ventricular epicardial action potential. This is accomplished by augmentation of ICa using □□adrenergic agents or phosphodiesterase III inhibitors or via inhibition of Ito. Radiofrequency ablation of the right ventricular outward flow tract epicardium is effective in suppressing arrhythmogenesis in BrS patients experiencing frequent appropriate ICD-shocks. Expert commentary: Understanding of the pathophysiology and approach to therapy of BrS has advanced considerably in recent years, but there remains an urgent need for development of cardio-selective and ion-channel-specific Ito blockers for treatment of BrS.
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Affiliation(s)
- Mariana Argenziano
- a Cardiovascular Research , Lankenau Institute for Medical Research , Wynnewood , PA , USA
| | - Charles Antzelevitch
- a Cardiovascular Research , Lankenau Institute for Medical Research , Wynnewood , PA , USA.,b Cardiovascular Research , Lankenau Heart Institute , Wynnewood , PA , USA.,c Department of Medicine and Pharmacology and Experimental Therapeutics , Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia , PA , USA
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15
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Shelke A, Tachil A, Saggu D, Jesuraj ML, Yalagudri S, Narasimhan C. Catheter ablation for electrical storm in Brugada syndrome: Results of substrate based ablation. Indian Heart J 2018; 70:296-302. [PMID: 29716710 PMCID: PMC5993914 DOI: 10.1016/j.ihj.2017.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 06/23/2017] [Accepted: 07/29/2017] [Indexed: 11/17/2022] Open
Abstract
Background Brugada syndrome (BrS) is known to cause malignant ventricular arrhythmia (VA) and sudden cardiac death (SCD). Patients with implantable cardioverter defibrillator (ICD) may experience recurrent shocks from ICD. Recent reports indicate that radiofrequency ablation (RFA) in BrS is feasible, and effective. Catheter ablation of premature ventricular complexes (PVCs) triggering VA and substrate modification of right ventricular outflow tract (RVOT) has been described. Methods and results Five patients (4 males, age-23 to 32 years) with BrS and electrical storm (ES) despite being on isoprenaline infusion and cilostazol (phosphodiestrase-3 inhibitor) underwent 3 dimensional electroanatomic mapping and RFA. Ventricular fibrillation was easily inducible in two patients. Voltage map of right ventricle was created in sinus rhythm in all patients. Substrate modification of RVOT was performed endocardially in one patient, both endocardial and epicardial in three and only epicardially in one patient. Brugada pattern gradually resolved over one week in all patients post procedure. These patients completed follow up of median 40 months (1.5–70). One patient had inappropriate shock due to atrial fibrillation, one had an episode of VF and appropriate shock 24 months after the RFA. The remaining four patients had no device therapy or VA in device log on follow up. Conclusion Abnormal myocardial substrate is observed in RVOT among patients with BrS. Substrate modification in these patients may abolish Brugada pattern on the ECG and prevents spontaneous VAs on long term follow up.
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Affiliation(s)
- Abhijeet Shelke
- Department of Cardiology, Krishna Institute of Medical Sciences, Karad, Satara, Maharashtra, India
| | - Ajit Tachil
- Department of Cardiology, Lisie Hospital, Kochi, Kerala, India
| | - Daljeet Saggu
- Department of Arrhythmia and Electrophysiology, CARE Hospital, Hyderabad, India
| | - Masilamani Lawrance Jesuraj
- Department of Interventional Cardiology and Electrophysiology, Kovai Medical Centre and Hospital, Hyderabad, India
| | - Sachin Yalagudri
- Department of Arrhythmia and Electrophysiology, CARE Hospital, Hyderabad, India
| | - Calambur Narasimhan
- Department of Arrhythmia and Electrophysiology, CARE Hospital, Hyderabad, India.
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16
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Rivard L, Andrade J. Innovative Approaches to Arrhythmic Storm: The Growing Role of Interventional Procedures. Can J Cardiol 2017; 33:44-50. [DOI: 10.1016/j.cjca.2016.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/09/2016] [Accepted: 10/09/2016] [Indexed: 10/20/2022] Open
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17
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Steinfurt J, Biermann J, Bode C, Odening KE. The Diagnosis, Risk Stratification, and Treatment of Brugada Syndrome. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:394-401. [PMID: 26157012 DOI: 10.3238/arztebl.2015.0394] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 03/16/2015] [Accepted: 03/16/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Brugada syndrome (BrS) is among the more common familial arrhythmia syndromes, with an estimated prevalence of 1 to 5 per 10 000 persons. It is characterized by a right ventricular conduction delay, dynamic or persistent ST-segment elevations in the precordial leads V1-3 , and an elevated risk of syncope and sudden cardiac death in young adults without structural heart disease. METHODS This article is based on original and review articles on BrS that appeared in English from 2010 onward and were retrieved by a selective search in PubMed, with special attention to international consensus publications on inherited arrhythmogenic diseases. RESULTS According to the new diagnostic criteria, the diagnosis of BrS requires typical ECG changes in only one precordial lead. This will likely increase sensitivity, but may also lead to an increase in asymptomatic patients. Established risk markers include sudden cardiac arrest and a spontaneous type 1 ECG with arrhythmic syncope. Patients with these findings benefit from the implantation of a cardioverter-defibrillator. There is no validated algorithm for risk stratification of asymptomatic patients. Because of the low prevalence of BrS, there have been no randomized controlled trials (RCTs) in this disease, and all recommendations are based on expert opinion. BrS is usually inherited in an autosomal dominant manner. Recently discovered gene polymorphisms modify the risk of BrS, challenging the conception of BrS as a monogenetic disease. Electro-anatomic mapping studies have revealed, for the first time, an arrhythmogenic substrate over the right ventricular outflow tract in BrS patients. CONCLUSION BrS is one important differential diagnosis to consider in patients presenting with syncope or sudden cardiac arrest. The goal of current research is to achieve a deeper understanding of the genetic and electrophysiological changes underlying BrS. Further insights in these areas will probably enable better risk stratification of asymptomatic BrS patients in the future.
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Affiliation(s)
- Johannes Steinfurt
- Department of Cardiology and Angiology I, University Heart Center Freiburg · Bad Krozingen
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18
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Belhassen B. Management of Brugada Syndrome 2016: Should All High Risk Patients Receive an ICD? Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004185. [DOI: 10.1161/circep.116.004185] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Bernard Belhassen
- From the Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel
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19
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Saha SA, Krishnan K, Madias C, Trohman RG. Combined Right Ventricular Outflow Tract Epicardial and Endocardial Late Potential Ablation for Treatment of Brugada Storm: A Case Report and Review of the Literature. Cardiol Ther 2016; 5:229-243. [PMID: 27646458 PMCID: PMC5125114 DOI: 10.1007/s40119-016-0072-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Indexed: 12/11/2022] Open
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.
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Affiliation(s)
- Sandeep A Saha
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA.
| | - Kousik Krishnan
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Christopher Madias
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Richard G Trohman
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
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20
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Shah AJ, Hocini M, Denis A, Derval N, Sacher F, Jais P, Haissaguerre M. Polymorphic Ventricular Tachycardia/Ventricular Fibrillation and Sudden Cardiac Death in the Normal Heart. Card Electrophysiol Clin 2016; 8:581-591. [PMID: 27521091 DOI: 10.1016/j.ccep.2016.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Primary electrical diseases manifest with polymorphic ventricular tachycardia (PMVT) and ventricular fibrillation (VF) and along with idiopathic VF contribute to about 10% of sudden cardiac deaths (SCDs) overall. These disorders include long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, short QT syndrome, and early repolarization syndrome. This article reviews the clinical electrophysiological management of PMVT/VF in a structurally normal heart affected with these disorders.
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Affiliation(s)
- Ashok J Shah
- Cardio Vascular Services, South Consulting Suites, Peel Health Campus, 110 Lakes Road, Mandurah, Western Australia 6210, Australia.
| | - Meleze Hocini
- Department of Electrophysiology and Cardiac Pacing, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, Pessac Cedex 33604, France
| | - Arnaud Denis
- Department of Electrophysiology and Cardiac Pacing, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, Pessac Cedex 33604, France
| | - Nicolas Derval
- Department of Electrophysiology and Cardiac Pacing, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, Pessac Cedex 33604, France
| | - Frederic Sacher
- Department of Electrophysiology and Cardiac Pacing, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, Pessac Cedex 33604, France
| | - Pierre Jais
- Department of Electrophysiology and Cardiac Pacing, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, Pessac Cedex 33604, France
| | - Michel Haissaguerre
- Department of Electrophysiology and Cardiac Pacing, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, Pessac Cedex 33604, France.
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21
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Hayashi T, Nitta J, Goya M, Isobe M, Hirao K. Endocardial-only catheter ablation with substantial improvement in ventricular fibrillation recurrences in a patient with Brugada syndrome. HeartRhythm Case Rep 2016; 2:428-431. [PMID: 28491726 PMCID: PMC5419967 DOI: 10.1016/j.hrcr.2016.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Tatsuya Hayashi
- Department of Cardiology, Saitama Red Cross Hospital, Saitama, Japan
| | - Junichi Nitta
- Department of Cardiology, Saitama Red Cross Hospital, Saitama, Japan
| | | | | | - Kenzo Hirao
- Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
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22
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Murakoshi N, Aonuma K. Catheter ablation for ventricular tachyarrhythmia in patients with channelopathies. J Arrhythm 2016; 32:404-410. [PMID: 27761165 PMCID: PMC5063265 DOI: 10.1016/j.joa.2016.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 12/16/2015] [Accepted: 01/05/2016] [Indexed: 12/31/2022] Open
Abstract
Drug treatment and/or implantable cardioverter defibrillator (ICD) implantation are the most widely accepted first-line therapies for channelopathic patients who have recurrent syncope, sustained ventricular tachycardia (VT), or documented ventricular fibrillation (VF), or are survivors of cardiac arrest. In recent years, there have been significant advances in mapping techniques and ablation technology, coupled with better understanding of the mechanisms of ventricular tachyarrhythmia in channelopathies. Catheter ablation has provided important insights into the role of the Purkinje network and the right ventricular outflow tract in the initiation and perpetuation of VT/VF, and has evolved as a promising treatment modality for ventricular tachyarrhythmia even in channelopathies. When patients are exposed to a high risk of sudden cardiac death or deterioration of their quality of life due to episodes of tachycardia and frequent ICD discharges, catheter ablation may be an effective treatment option to reduce the risk of sudden cardiac death and decrease the frequency of cardiac events. In this review, we summarize the current understanding of catheter ablation for VT/VF in patients with channelopathies including Brugada syndrome, idiopathic VF, long QT syndrome, and catecholaminergic polymorphic VT.
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Affiliation(s)
- Nobuyuki Murakoshi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
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23
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Bürkle G, Schäfer H, Marschall C, Brugada P, Ehrlich JR. Pharmacological Provocation of Outflow-Tract Tachycardia in a Patient With Brugada Syndrome. Can J Cardiol 2016; 32:1577.e5-1577.e7. [PMID: 27032887 DOI: 10.1016/j.cjca.2016.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 01/01/2016] [Accepted: 01/24/2016] [Indexed: 11/16/2022] Open
Abstract
We present a case of a symptomatic patient with Brugada syndrome, who had sustained right ventricular outflow tract tachycardia after pronounced exercise-induced ST segment elevation in V1 and V2. In electrophysiological study he developed right ventricular outflow tract tachycardia provoked by combined infusion of ajmaline and orciprenaline. After ablation no further arrhythmia was provoked by pharmacological stimulation.
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Affiliation(s)
- Gerd Bürkle
- Cardiology, St Josefs-Hospital, Wiesbaden, Germany
| | - Henry Schäfer
- Intensive Care Medicine, Bürgerhospital, Frankfurt, Germany
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24
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Jiménez A, Olaya A, Morales N, Sánchez J. Capítulo 14. Utilidad del mapeo tridimensional en la ablación de taquicardia ventricular en pacientes con miocardiopatía hipertrófica, taquicardia ventricular catecolaminérgica y síndrome de Brugada. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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25
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Antzelevitch C, Patocskai B. Brugada Syndrome: Clinical, Genetic, Molecular, Cellular, and Ionic Aspects. Curr Probl Cardiol 2016; 41:7-57. [PMID: 26671757 PMCID: PMC4737702 DOI: 10.1016/j.cpcardiol.2015.06.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Brugada syndrome (BrS) is an inherited cardiac arrhythmia syndrome first described as a new clinical entity in 1992. Electrocardiographically characterized by distinct coved type ST segment elevation in the right-precordial leads, the syndrome is associated with a high risk for sudden cardiac death in young adults, and less frequently in infants and children. The electrocardiographic manifestations of BrS are often concealed and may be unmasked or aggravated by sodium channel blockers, a febrile state, vagotonic agents, as well as by tricyclic and tetracyclic antidepressants. An implantable cardioverter defibrillator is the most widely accepted approach to therapy. Pharmacologic therapy is designed to produce an inward shift in the balance of currents active during the early phases of the right ventricular action potential (AP) and can be used to abort electrical storms or as an adjunct or alternative to device therapy when use of an implantable cardioverter defibrillator is not possible. Isoproterenol, cilostazol, and milrinone boost calcium channel current and drugs like quinidine, bepridil, and the Chinese herb extract Wenxin Keli inhibit the transient outward current, acting to diminish the AP notch and thus to suppress the substrate and trigger for ventricular tachycardia or fibrillation. Radiofrequency ablation of the right ventricular outflow tract epicardium of patients with BrS has recently been shown to reduce arrhythmia vulnerability and the electrocardiographic manifestation of the disease, presumably by destroying the cells with more prominent AP notch. This review provides an overview of the clinical, genetic, molecular, and cellular aspects of BrS as well as the approach to therapy.
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Affiliation(s)
| | - Bence Patocskai
- Masonic Medical Research Laboratory, Utica, NY 13501
- Department of Pharmacology & Pharmacotherapy, University of Szeged, Szeged, Hungary
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26
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Saggu DK, Nair SG, Shelke A, Yalagudri S, Narasimhan C. Catheter ablation of recurrent polymorphic tachycardia: Use of sodium channel blockade to organize the tachycardia: A case report. Indian Pacing Electrophysiol J 2015; 15:300-2. [PMID: 27479202 PMCID: PMC4867967 DOI: 10.1016/j.ipej.2015.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A 55 year old male presented with recurrent implantable cardioverter defibrillator (ICD) shocks due to polymorphic ventricular tachycardia (PMVT). He had undergone prior catheter ablation for VT three years ago. During the prior attempt he underwent voltage guided substrate ablation. With programmed ventricular extrastimulation (PVES), PMVT was repeatedly induced requiring DC shock. Intravenous procainamide was administered and PVES was repeated which induced sustained monomorphic ventricular tachycardia (MMVT). This VT had pseudo delta waves with maximum deflection index of 0.68, suggestive of epicardial origin. Activation mapping was performed epicardially. Presystolic potentials were recorded in mid anterolateral wall of left ventricular epicardial region. Radiofrequency (RF) ablation at this site terminated the VT. Post ablation there was no inducible tachycardia and patient is free of arrhythmias during 2 years of follow-up.
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27
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Yamasaki H, Tada H, Sekiguchi Y, Aonuma K. Right coronary cusp as a new window of ablation for pilsicainide-induced ventricular premature contractions in a patient with Brugada syndrome. Heart Vessels 2015; 31:1397-401. [DOI: 10.1007/s00380-015-0760-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 10/02/2015] [Indexed: 10/22/2022]
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28
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Atoui M, Gunda S, Lakkireddy D, Mahapatra S. Radiofrequency Ablation to Prevent Sudden Cardiac Death. Methodist Debakey Cardiovasc J 2015; 11:121-8. [PMID: 26306130 DOI: 10.14797/mdcj-11-2-121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Radiofrequency ablation may prevent or treat atrial and ventricular arrhythmias. Since some of these arrhythmias are associated with sudden cardiac death, it has been hypothesized that ablation may prevent sudden death in certain cases. We performed a literature search to better understand under which circumstances ablation may prevent sudden death and found little randomized data demonstrating the long-term effects of ablation. Current literature shows that ablation clearly prevents symptoms of arrhythmia and may reduce the incidence of sudden cardiac death in select patients, although data does not indicate improved mortality. Ongoing clinical trials are needed to better define the role of ablation in preventing sudden cardiac death.
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Affiliation(s)
| | - Sampath Gunda
- University of Kansas Medical Center, Kansas City, Kansas
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29
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Looi KL, Tang A, Agarwal S. Ventricular arrhythmia storm in the era of implantable cardioverter-defibrillator. Postgrad Med J 2015; 91:519-26. [DOI: 10.1136/postgradmedj-2015-133550] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 08/02/2015] [Indexed: 11/04/2022]
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30
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Abstract
A prominent J wave is encountered in a number of life-threatening cardiac arrhythmia syndromes, including the Brugada syndrome and early repolarization syndromes. Brugada syndrome and early repolarization syndromes differ with respect to the magnitude and lead location of abnormal J waves and are thought to represent a continuous spectrum of phenotypic expression termed J-wave syndromes. Despite two decades of intensive research, risk stratification and the approach to therapy of these 2 inherited cardiac arrhythmia syndromes are still undergoing rapid evolution. Our objective in this review is to provide an integrated synopsis of the clinical characteristics, risk stratifiers, and molecular, ionic, cellular, and genetic mechanisms underlying these 2 fascinating syndromes that have captured the interest and attention of the cardiology community in recent years.
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Affiliation(s)
| | - Gan-Xin Yan
- Lankenau Institute for Medical Research and Lankenau Medical Center, Wynnewood, Pennsylvania; Jefferson Medical College, Philadelphia, Pennsylvania; The First Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, China
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Patocskai B, Antzelevitch C. Novel Therapeutic Strategies for the Management of Ventricular Arrhythmias Associated with the Brugada Syndrome. Expert Opin Orphan Drugs 2015; 3:633-651. [PMID: 27559494 PMCID: PMC4993532 DOI: 10.1517/21678707.2015.1037280] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Brugada syndrome (BrS) is an inherited cardiac arrhythmia syndrome characterized by prominent J waves appearing as distinct coved type ST segment elevation in the right precordial leads of the ECG. It is associated with a high risk for sudden cardiac death. AREAS COVERED We discuss 1) ECG manifestations of BrS which can be unmasked or aggravated by sodium channel blockers, febrile states, vagotonic agents, as well as tricyclic and tetracyclic antidepressants; 2) Genetic basis of BrS; 3) Ionic and cellular mechanisms underlying BrS; 4) Therapy involving devices including an implantable cardioverter defibrillator (ICD); 5) Therapy involving radiofrequency ablation; and 6) Therapy involving pharmacological therapy which is aimed at producing an inward shift in the balance of the currents active during phase 1 of the right ventricular action potential either by boosting calcium channel current (isoproterenol, cilostazol and milrinone) or by inhibition of transient outward current Ito (quinidine, bepridil and the Chinese herb extract Wenxin Keli). EXPERT OPINION This review provides an overview of the clinical and molecular aspects of BrS with a focus on approaches to therapy. Available data suggest that agents capable of inhibiting the transient outward current Ito can exert an ameliorative effect regardless of the underlying cause.
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Affiliation(s)
- Bence Patocskai
- Department of Pharmacology & Pharmacotherapy, University of Szeged, Szeged, Hungary
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van Hoeijen DA, Blom MT, Tan HL. Cardiac sodium channels and inherited electrophysiological disorders: an update on the pharmacotherapy. Expert Opin Pharmacother 2014; 15:1875-87. [PMID: 24992280 DOI: 10.1517/14656566.2014.936380] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Since the recognition of inherited sodium (Na(+)) channel disease, the cardiac Na(+) channel has been extensively studied. Both loss-of-function and gain-of-function mutations of the cardiac Na(+) channel are associated with cardiac arrhythmia and sudden cardiac death. Pathophysiological mechanisms that may induce arrhythmia are unravelled and include alterations in biophysical properties due to the mutation in SCN5A, drug use and circumstantial factors. Insights into the mechanisms of inherited Na(+) channel disease may result in tailored therapy. However, due to the complexity of cardiac electrical activity and pathophysiological mechanisms, pharmacotherapy in cardiac Na(+) channel disease remains challenging. AREAS COVERED This review discusses various mechanisms involved in inherited Na(+) channel disorders, focussing on Brugada syndrome (Brs) and long QT syndrome type 3 (LQTS3). It aims to provide an overview of developments in pharmacotherapy, discussing both treatment and which drugs to avoid to prevent arrhythmia. EXPERT OPINION Altered biophysical properties of cardiac Na(+) channels are the basis of arrhythmias in patients with inherited Na(+) channel diseases such as BrS and LQTS3. The effects of such biophysical derangements are strongly modulated by concomitant factors. Tailored drug therapy is required to prevent arrhythmia and is best achieved by educating patients affected by Na(+) channel disorders.
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Affiliation(s)
- Daniel A van Hoeijen
- University of Amsterdam, Academic Medical Center, Department of Cardiology , P.O. Box 22660, 1100 DD, Amsterdam , The Netherlands +0031 20 566 3264 ; +0031 20 566 9131 ;
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Sethi KK, Sethi K, Chutani SK. Early repolarisation and J wave syndromes. Indian Heart J 2014; 66:443-52. [PMID: 25173204 PMCID: PMC4150048 DOI: 10.1016/j.ihj.2014.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 06/16/2014] [Indexed: 12/21/2022] Open
Abstract
J wave syndrome has emerged as a significant cause of Idiopathic ventricular fibrillation (IVF) responsible for sudden cardiac death. A large body of data is now available on genesis, genetics and ionic mechanisms of J wave syndromes. Two of these viz., Early repolarization syndrome (ER) and Brugada syndrome (BrS) are fairly well characterized enabling correct diagnosis in most patients. The first part of repolarization of ventricular myocardium is governed by Ito current i.e., rapid outward potassium current. The proposed mechanism of ventricular fibrillation (VF) and ventricular tachycardia (VT) storms is the faster Ito current in the epicardium than in the endocardium results in electrical gradient that forms the substrate for phase 2 reentry. Prevention of Ito current with quinidine supports this mechanism. Majority of ER patterns in young patients are benign. The key issue is to identify those at increased risk of sudden cardiac death. Association of both ER syndrome and Brugada syndrome with other disease states like coronary artery disease has also been reported. Individuals resuscitated from VF definitely need an implantable cardiac defibrillator (ICD) but in others there is no consensus regarding therapy. Role of electrophysiology study to provoke ventricular tachycardia or fibrillation is not yet well defined. Radiofrequency ablation of epicardial substrate in right ventricle in Brugada syndrome is also under critical evaluation. In this review we shall discuss historical features, epidemiology, electrocardiographic features, ionic pathogenesis, clinical features and current status of proposed treatment of ER and BrS.
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Affiliation(s)
- Kamal K Sethi
- Director of Cardiology, Division of Cardiology and Cardiac Electrophysiology, Delhi Heart & Lung Institute, 3 MM II, Panchkuian Road, New Delhi 110 055, India.
| | - Kabir Sethi
- Division of Cardiology and Cardiac Electrophysiology, Delhi Heart & Lung Institute, 3 MM II, Panchkuian Road, New Delhi 110 055, India
| | - Surendra K Chutani
- Division of Cardiology and Cardiac Electrophysiology, Delhi Heart & Lung Institute, 3 MM II, Panchkuian Road, New Delhi 110 055, India
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Cortez-Dias N, Plácido R, Marta L, Bernardes A, Sobral S, Carpinteiro L, de Sousa J. Epicardial ablation for prevention of ventricular fibrillation in a patient with Brugada syndrome. Rev Port Cardiol 2014; 33:305.e1-7. [PMID: 24931179 DOI: 10.1016/j.repc.2014.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 12/23/2013] [Accepted: 01/02/2014] [Indexed: 11/17/2022] Open
Abstract
We present the case of a 60-year-old woman with Brugada syndrome, permanent type 1 electrocardiographic pattern, who had previously received an implantable cardioverter-defibrillator. She suffered frequent syncopal episodes and multiple appropriate shocks (around five per month) due to polymorphic ventricular tachycardia/ventricular fibrillation, refractory to quinidine therapy. Combined epicardial and endocardial electroanatomical mapping was performed with a view to substrate ablation. An area of abnormal fractionated electrograms, lasting up to 370 ms and up to 216 ms after the end of the surface QRS, was identified in the epicardium in the lower anterior part of the right ventricular outflow tract. Extensive epicardial ablation of this area, which eliminated the fractionated electrograms, led to the disappearance of the Brugada electrocardiographic pattern six weeks after ablation. Despite discontinuation of quinidine, no further ventricular arrhythmias occurred during follow-up, which is still of short duration.
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Affiliation(s)
- Nuno Cortez-Dias
- Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Cardiologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
| | - Rui Plácido
- Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Cardiologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Liliana Marta
- Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Serviço de Cardiologia, Hospital Distrital de Santarém, Santarém, Portugal
| | - Ana Bernardes
- Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | - Sílvia Sobral
- Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | - Luís Carpinteiro
- Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Cardiologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - João de Sousa
- Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Cardiologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Cortez-Dias N, Plácido R, Marta L, Bernardes A, Sobral S, Carpinteiro L, de Sousa J. Epicardial ablation for prevention of ventricular fibrillation in a patient with Brugada Syndrome. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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HRS/EHRA/APHRS Expert Consensus Statement on the Diagnosis and Management of Patients with Inherited Primary Arrhythmia Syndromes. J Arrhythm 2014. [DOI: 10.1016/j.joa.2013.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Priori SG, Wilde AA, Horie M, Cho Y, Behr ER, Berul C, Blom N, Brugada J, Chiang CE, Huikuri H, Kannankeril P, Krahn A, Leenhardt A, Moss A, Schwartz PJ, Shimizu W, Tomaselli G, Tracy C. Executive Summary: HRS/EHRA/APHRS Expert Consensus Statement on the Diagnosis and Management of Patients with Inherited Primary Arrhythmia Syndromes. J Arrhythm 2014. [DOI: 10.1016/j.joa.2013.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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38
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Priori SG, Wilde AA, Horie M, Cho Y, Behr ER, Berul C, Blom N, Brugada J, Chiang CE, Huikuri H, Kannankeril P, Krahn A, Leenhardt A, Moss A, Schwartz PJ, Shimizu W, Tomaselli G, Tracy C. HRS/EHRA/APHRS Expert Consensus Statement on the Diagnosis and Management of Patients with Inherited Primary Arrhythmia Syndromes. Heart Rhythm 2013; 10:1932-63. [DOI: 10.1016/j.hrthm.2013.05.014] [Citation(s) in RCA: 1341] [Impact Index Per Article: 121.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Indexed: 12/15/2022]
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Kautzner J, Peichl P. Catheter Ablation of Polymorphic Ventricular Tachycardia and Ventricular Fibrillation. Arrhythm Electrophysiol Rev 2013; 2:135-40. [PMID: 27532017 DOI: 10.15420/aer.2013.2.2.135] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 09/16/2013] [Indexed: 11/04/2022] Open
Abstract
Recently, catheter ablation (CA) has become a therapeutic option to target focal triggers of polymorphic ventricular tachycardia and ventricular fibrillation (VF) in the setting of electrical storm (ES). This strategy was first described in subjects without organic heart disease (i.e. idiopathic VF) and subsequently in other conditions, especially in patients with ischaemic heart disease. In the majority of cases, the triggering focus originates in the ventricular Purkinje system. In patients with Brugada syndrome, besides ablation of focal trigger in the right ventricular outflow tract, modification of a substrate in this region has been described to prevent recurrences of VF. In conclusion, CA appears to be a reasonable strategy for intractable cases of ES due to focally triggered polymorphic ventricular tachycardia and VF. Therefore, early transport of the patient into the experience centre for CA should be considered since the procedure could be in some cases life-saving. Therefore, the awareness of this entity and link to the nearest expert centre are important.
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Affiliation(s)
| | - Petr Peichl
- Consultant Electrophysiologist, Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Schleifer JW, Mookadam F, Srivathsan K. Recent developments in the ablation of ventricular arrhythmias. Future Cardiol 2013; 9:799-808. [PMID: 24180538 DOI: 10.2217/fca.13.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Catheter ablation for the management of recurrent ventricular arrhythmias (VAs) is an emerging technology, with good efficacy in selected patients. It is an effective treatment for recurrent VA and can terminate VA during electrical storm. Recent innovations enhance the accuracy of ventricular mapping, allowing for substrate modification while the patient remains in sinus rhythm, thus facilitating the treatment of different types of VA. Epicardial ablation is now a feasible option for treating VA and increases the likelihood of success in certain types of VA. Percutaneous hemodynamic support facilitates successful ablation during poorly tolerated VA. This article reviews recent advances in catheter ablation techniques for VA and approaches to the management of specific types of VA, with a view toward future developments.
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Affiliation(s)
- John William Schleifer
- Mayo Clinic Arizona, Division of Cardiovascular Diseases, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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Priori SG, Wilde AA, Horie M, Cho Y, Behr ER, Berul C, Blom N, Brugada J, Chiang CE, Huikuri H, Kannankeril P, Krahn A, Leenhardt A, Moss A, Schwartz PJ, Shimizu W, Tomaselli G, Tracy C, Ackerman M, Belhassen B, Estes NAM, Fatkin D, Kalman J, Kaufman E, Kirchhof P, Schulze-Bahr E, Wolpert C, Vohra J, Refaat M, Etheridge SP, Campbell RM, Martin ET, Quek SC. Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Europace 2013; 15:1389-406. [PMID: 23994779 DOI: 10.1093/europace/eut272] [Citation(s) in RCA: 408] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Silvia G Priori
- From the Maugeri Foundation IRCCS, Pavia, Italy, Department of Molecular Medicine, University of Pavia, Pavia, Italy, and New York University, New York, New York
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Abstract
More than 20 years have passed since the description of Brugada syndrome as a clinical entity. The original case series depicted patients who all had coved ST-segment elevation in the right precordial leads, associated with a high risk of sudden death and no apparent structural heart disease. As subsequent registry data were published, it became apparent that the spectrum of risk is wide, with the majority of patients classified as low risk. Two consensus documents have been published that will continue to be updated. Despite intense research efforts, many controversies still exist over its pathophysiology and the risk stratification for sudden death. Management continues to be challenging with a lack of drug therapy and high complication rates from implantable cardioverter defibrillators. In this review, we highlight the current state-of-the-art therapies and their controversies.
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Affiliation(s)
- Anthony Li
- Cardiovascular Sciences Research Centre, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
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Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Heart Rhythm 2013; 10:e85-108. [PMID: 23916535 DOI: 10.1016/j.hrthm.2013.07.021] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Indexed: 02/07/2023]
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Márquez MF, Bonny A, Hernández-Castillo E, De Sisti A, Gómez-Flores J, Nava S, Hidden-Lucet F, Iturralde P, Cárdenas M, Tonet J. Long-term efficacy of low doses of quinidine on malignant arrhythmias in Brugada syndrome with an implantable cardioverter-defibrillator: A case series and literature review. Heart Rhythm 2012; 9:1995-2000. [DOI: 10.1016/j.hrthm.2012.08.027] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Indexed: 10/27/2022]
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Abstract
Two decades ago, a series of 8 idiopathic ventricular fibrillation patients who each had an abnormal ECG (right bundle branch block with coved-type ECG), but otherwise had normal hearts were described by Brugada and Brugada. Since then, the clinical entity has become known as Brugada syndrome (BS). Shortly thereafter, mutations of the SCN5A gene that encodes for the α-subunit of the sodium channel were found, galvanizing the field of ion channelopathies following in the footsteps of the breakthrough in long QT syndrome. Over the past 20 years, extensive research in this field has produced major progress toward better understanding of BS and the gaining of knowledge of the genetic background, pathophysiology and new management. Two consensus reports were published to help define the diagnostic criteria, risk stratification and management of BS patients. However, there are controversies. In this review, we will share our experiences of BS patients in Thailand and discuss advances in many aspects of the syndrome (ie, genetics and pathophysiology) and some of these pertinent controversies, as well as new treatment of the syndrome with catheter ablation.
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Affiliation(s)
- Gumpanart Veerakul
- Cardiovascular Research and Prevention Center, Bhumibol Adulyadej Hospital and Pacific Rim Electrophysiology Research, Bangkok, Thailand
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LOWERY CHRISTOPHERM, TZOU WENDYS, ALEONG RYANG, NGUYEN DUYT, VAROSY PAULD, KATZ DAVIDF, HEATH RUSSELLR, SCHULLER JOSEPHL, LEWKOWIEZ LAURENT, SAUER WILLIAMH. Use of Stored Implanted Cardiac Defibrillator Electrograms in Catheter Ablation of Ventricular Fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 36:76-85. [DOI: 10.1111/pace.12019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 07/23/2012] [Accepted: 08/21/2012] [Indexed: 11/30/2022]
Affiliation(s)
- CHRISTOPHER M. LOWERY
- From the Section of Cardiac Electrophysiology; University of Colorado, School of Medicine; Aurora; Colorado
| | - WENDY S. TZOU
- From the Section of Cardiac Electrophysiology; University of Colorado, School of Medicine; Aurora; Colorado
| | - RYAN G. ALEONG
- From the Section of Cardiac Electrophysiology; University of Colorado, School of Medicine; Aurora; Colorado
| | - DUY T. NGUYEN
- From the Section of Cardiac Electrophysiology; University of Colorado, School of Medicine; Aurora; Colorado
| | - PAUL D. VAROSY
- From the Section of Cardiac Electrophysiology; University of Colorado, School of Medicine; Aurora; Colorado
| | - DAVID F. KATZ
- From the Section of Cardiac Electrophysiology; University of Colorado, School of Medicine; Aurora; Colorado
| | - RUSSELL R. HEATH
- From the Section of Cardiac Electrophysiology; University of Colorado, School of Medicine; Aurora; Colorado
| | - JOSEPH L. SCHULLER
- From the Section of Cardiac Electrophysiology; University of Colorado, School of Medicine; Aurora; Colorado
| | - LAURENT LEWKOWIEZ
- From the Section of Cardiac Electrophysiology; University of Colorado, School of Medicine; Aurora; Colorado
| | - WILLIAM H. SAUER
- From the Section of Cardiac Electrophysiology; University of Colorado, School of Medicine; Aurora; Colorado
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SUNSANEEWITAYAKUL BUNCHA, YAO YAN, THAMAREE SUTHASINEE, ZHANG SHU. Endocardial Mapping and Catheter Ablation for Ventricular Fibrillation Prevention in Brugada Syndrome. J Cardiovasc Electrophysiol 2012; 23 Suppl 1:S10-6. [DOI: 10.1111/j.1540-8167.2012.02433.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lü CM, Zhang ZX, Li L, Tang JM, Feng HX. Study on the relationship between myocardial ischemia assessed by 24-hour ambulatory electrocardiogram and ventricular premature beat originating from different positions in older adults. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2012.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Tan VH, Yap J, Hsu, LF, Liew R. Catheter ablation of ventricular fibrillation triggers and electrical storm. Europace 2012; 14:1687-95. [DOI: 10.1093/europace/eus050] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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