Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.
Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.
Heart Rhythm. 2019 Jun;16(6):879-887. doi: 10.1016/j.hrthm.2018.12.026. Epub 2018 Dec 27.
Abnormal delayed electrograms (EGMs) from the anterior wall of the right ventricular outflow tract (RVOT) epicardium have become the ablation target in Brugada syndrome (BrS).
The aim of this study was to analyze the safety, feasibility, and efficacy of a novel hybrid thoracoscopic approach to perform epicardial RVOT radiofrequency ablation in BrS.
Thirty-six patients with BrS (26 men (72.2%); mean age 36.6±15.8 years; range 3-63 years) who underwent hybrid thoracoscopic epicardial ablation of RVOT from January 2016 to April 2018 were included in this study. Two expert electrophysiologists analyzed the EGMs during ajmaline challenge and guided the surgeon to perform ablation. Ajmaline challenge was repeated after 1 month to assess the absence of the BrS electrocardiographic pattern. Patients were followed by remote monitoring and outpatient visits every 6 months.
The elimination of all abnormal EGMs was achieved in 94.4% of patients. After a mean follow-up of 16 ± 8 months (range 6-30 months), freedom from ventricular arrhythmias was obtained in 7 (77.8%) patients in secondary prevention 9/36 (25%) and in 24 (100%) patients in primary prevention 24/36 (75%). Major complications were observed in 1 patient (2.8%), who experienced late cardiac tamponade.
Hybrid thoracoscopic epicardial RVOT ablation in BrS is a safe and feasible approach, allowing direct visualization of ablation during radiofrequency delivery. Because of ventricular arrhythmia recurrences, implantable cardioverter-defibrillator implantation is still mandatory in patients treated in secondary prevention and with high risk.
右心室流出道（RVOT）心外膜前壁异常延迟电图（EGM）已成为Brugada 综合征（BrS）消融的靶点。
本研究旨在分析一种新型杂交胸腔镜方法进行 BrS 心外膜 RVOT 射频消融的安全性、可行性和疗效。
本研究纳入 2016 年 1 月至 2018 年 4 月期间 36 例接受杂交胸腔镜 RVOT 心外膜消融的 BrS 患者（男 26 例（72.2%）；平均年龄 36.6±15.8 岁；年龄 3-63 岁）。两名电生理专家在阿马林挑战期间分析 EGM，并指导外科医生进行消融。1 个月后重复阿马林挑战以评估 BrS 心电图模式是否消失。通过远程监测和门诊随访每 6 个月进行随访。
94.4%的患者消除了所有异常 EGM。平均随访 16±8 个月（6-30 个月）后，二级预防中 7 例（77.8%）患者和一级预防中 24 例（100%）患者获得无室性心律失常。二级预防 36 例中的 9 例（25%）和一级预防 36 例中的 24 例（75%）患者发生心律失常复发。主要并发症见于 1 例（2.8%）患者，发生迟发性心脏压塞。
BrS 杂交胸腔镜心外膜 RVOT 消融是一种安全可行的方法，可在射频输送过程中直接观察消融情况。由于室性心律失常复发，在二级预防和高危患者中仍需植入式心脏复律除颤器。
