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Catheter ablation in highly symptomatic Brugada patients: a Dutch case series

  • D. M. Haanschoten
  • A. ElvanEmail author
  • P. G. Postema
  • J. J. J. Smit
  • A. Adiyaman
  • R. M. A. ter Bekke
  • N. Asaad
  • W. T. J. Aanhaanen
  • A. R. Ramdat Misier
  • P. P. H. M. Delnoy
  • H. J. G. M. Crijns
  • A. A. M. Wilde
Original Paper

Abstract

Aims

In the past few years, promising results were described in targeting the arrhythmogenic substrate of the epicardial right ventricular outflow tract (RVOT) region in patients with Brugada syndrome (BrS). In this report, we describe our experience with endo- and epicardial substrate mapping and ablation in a series of highly symptomatic BrS patients.

Methods

This case series consists of seven patients with clinical BrS diagnosis who underwent catheter ablation in two Dutch hospitals (Isala hospital Zwolle; and Amsterdam University Medical Centre, location AMC, Amsterdam) and Hamad Heart Hospital in Qatar between 2013 and 2017. All patients had an ICD and recurrent ventricular arrhythmia (VA) episodes. All patients underwent endo-and epicardial mapping of the RVOT region. Elimination of all abnormal potentials and disappearance of BrS ECG pattern during the ablation procedure was the aimed endpoint.

Results

The study group consisted of seven patients with mean age 45.6 ± 16.9 years. Five patients had SCN5A mutations. One patient was excluded from analysis, since ablation could not be performed due to a very large low-voltage area and was later diagnosed with arrhythmogenic right ventricular cardiomyopathy, associated with an SCN5A mutation. One patient underwent both endo- and epicardial ablation to eliminate VA. During a mean follow-up of 3.6 ± 1.5 years, 5/6 patients remained VA free with two patients continuing quinidine.

Conclusion

In patients with BrS and drug-refractory VA, ablation of the arrhythmogenic substrate in the RVOT region was associated with excellent long-term VA-free survival. The majority of these highly symptomatic BrS patients had an SCN5A mutation and also low-voltage areas epicardially.

Graphic abstract

Keywords

Brugada syndrome Catheter ablation Epicardial substrate 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • D. M. Haanschoten
    • 1
  • A. Elvan
    • 1
    Email author
  • P. G. Postema
    • 2
  • J. J. J. Smit
    • 1
  • A. Adiyaman
    • 1
  • R. M. A. ter Bekke
    • 3
  • N. Asaad
    • 4
  • W. T. J. Aanhaanen
    • 1
  • A. R. Ramdat Misier
    • 1
  • P. P. H. M. Delnoy
    • 1
  • H. J. G. M. Crijns
    • 3
  • A. A. M. Wilde
    • 2
  1. 1.Department of CardiologyIsala Heart CenterZwolleThe Netherlands
  2. 2.Academic Medical CenterAmsterdamThe Netherlands
  3. 3.Maastricht University Medical CentreMaastrichtThe Netherlands
  4. 4.Hamad Heart HospitalDohaQatar

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