Non-Contact Mapping of the Origin of Provoked Ventricular Tachycardia in Brugada Syndrome

Introduction: We investigated electrophysiological properties of the entire right ventricular (RV) endocardium of provoked ventricular tachycardia/ventricular fibrillation (VT/VF) in 2 patients with Brugada syndrome (BS). Methods: N/A. Results: Case 1. Type 3 Brugada type ECG which changed to type 1 ECG by class Ic antiarrhythmic drug, pilsicainide. Electrophysiologic study (EPS): Double ventricular premature stimuli from RVOT (600/260/200 ms) induced VF. The multielectrode array (Ensite, St. Jude Medical) was placed at the right ventricular outflow tract (RVO) and VF was induced again from RVOT (600/224/180 ms). Non-contact mapping during organized rapid VT before degenerating into VF showed that provoked VT arose from RVOT. Case 2: Type 1 Brugada type ECG. EPS: Triple ventricular premature stimuli from RV apex (600/250/220/200 ms) reproducibly induced VF. Non-contact mapping during organized rapid VT showed that provoked VT arose from RV free wall. Conclusion: RVOT and RV free wall appears to be crucial in the initiation and maintenance of VT with degeneration into VF in BS.

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