INVESTIGADORES
HONORE Stella Maris
capítulos de libros
Título:
Endocardial approach for substrate ablation in Brugada Syndrome
Autor/es:
TAUBER PE; MANSILLA V; BRUGADA P; SANCHEZ SS; HONORE SM; ELIZARI M; CORBALAN RR, ET AL.
Libro:
Cardiac Arrhythmias
Editorial:
InTechOpen
Referencias:
Año: 2018; p. 121 - 143
Resumen:
Background: Radiofrequency ablation (RFA) in Brugada síndrome (BrS) has been performed both endocardially and epicardially. The substrate in BrS is thus unclear. Objectives: To investigate the functional endocardial substrate and its correlation with clinical, electrophysiological and ECG findings in order to guide an endocardial ablation.Methods: Thirteen patients (38.7±12.3 years old) with spontaneous type 1 ECG BrS pattern, positive flecainide testing, inducible with programmed ventricular stimulation and with syncope without prodromes were enrolled. Patients underwent endocardial bipolar and electro-anatomic mapping with the purpose of identify areas of abnormal electrograms (EGMs) as target for RFA. During flecainide test, a greater total sum of ST segment elevation corresponded to a greater size of substrate.Results: When the greatest ST-segment elevation was in the 3rd intercostal space (ICS) or 4th ICS, the substrate was located in the longitudinal plane of the right ventricular outflow tract (RVOT). A QRS complex widening on its initial and final part, with prolonged transmural and regional depolarization time of RVOT corresponded to the substrate locateded in the anterior-lateral region of RVOT. A QRS complex widening rightwards and only prolonged transmural depolarization time corresponded with a substrate located in the anterior, anterior-septal or septal region of RVOT. RFA of endocardial substrate suppressed the inducibility and ECG BrS pattern during 34.7±15.5 months. After RFA, flecainide testing confirmed elimination of the ECG BrS pattern. Endocardial biopsy showed a correlation between functional and ultrastructural alterations in two patients. Conclusions: Endocardial RFA can eliminate the BrS phenotype and inducibility during PVS.