Division of Cardiology, Department of Medicine, Faculty of Medicine, Cardiac Center, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
J Cardiovasc Electrophysiol. 2012 Nov;23 Suppl 1:S10-6. doi: 10.1111/j.1540-8167.2012.02433.x. Epub 2012 Sep 18.
Endocardial Mapping and Ablation of Brugada Syndrome.
Brugada syndrome (BS) is characterized by ST-segment elevation in the right precordial electrocardiogram (ECG) leads and episodes of ventricular fibrillation (VF). This study aimed to observe the feasibility of substrate modification by radiofrequency catheter ablation and its effects on VF storm.
Ten BS patients (all men; median age 36.5 years) with VF storm (group I, n = 4) and no VF storm (group II, n = 6) were enrolled in the study between August 2007 and December 2008. All patients underwent electrophysiological study using noncontact mapping. The multielectrode array was placed in the right ventricular outflow tract (RVOT). The isopotential map was analyzed during sinus rhythm and the region that had electrical activity occurring during J point to +60 (J+60) milliseconds interval of the V1 or V2 of surface ECG was considered as the late activation zone (LAZ) and also the substrate for ablation. LAZ was found in RVOT with variable distribution in both groups. Endocardial catheter ablation of the LAZ modified Brugada ECG pattern in 3 of 4 patients (75%) and suppressed VF storm in all 4 patients in group I during long-term follow-up (12-30 months). One patient had complete right bundle branch block from the ablation procedure.
LAZ on RVOT identified by noncontact mapping may serve as potential VF substrate in BS patients with VF episodes. Radiofrequency ablation on LAZ normalized ECG, suppressed VF storm, and reduced VF recurrence. The procedure is safe and may prevent VF occurrence.
目的：观察射频导管消融对 Brugada 综合征（BS）患者室性心动过速（VT）风暴的有效性。
方法和结果：本研究共纳入 10 例 BS 患者，其中 VT 风暴患者 4 例（组 I），无 VT 风暴患者 6 例（组 II）。所有患者均进行了电生理检查，采用非接触式标测系统。多电极导管置于右心室流出道（RVOT）。在窦性心律下分析等电图，V1 或 V2 体表心电图 J 点后至+60 毫秒（J+60）的电活动区域被认为是延迟激活区（LAZ），也是消融的靶点。LAZ 在两组 RVOT 中分布不均。LAZ 的消融使 4 例组 I 患者中的 3 例（75%）的 Brugada 心电图模式得到改善，并在长期随访（12-30 个月）中抑制了所有 4 例患者的 VT 风暴。1 例患者因消融术出现完全性右束支阻滞。
结论：非接触式标测系统识别的 RVOT LAZ 可能是 BS 患者 VT 风暴的潜在 VT 基质。LAZ 的消融可使心电图正常化、抑制 VT 风暴、减少 VT 复发。该方法安全有效，可能预防 VT 发生。
