36 - Ablation of Genetically Triggered Ventricular Tachycardia/Fibrillation—Focusing on Brugada Syndrome

Abstract

Long considered a disorder of cardiac repolarization mediated by sodium channel mutations, Brugada Syndrome (BS) is now more clearly a disorder primarily of depolarization due to fibrosis on the epicardial aspect of the right ventricular outflow tract (RVOT). Fibrosis in this region leads to abnormal electrograms recorded from epicardial (but not endocardial) mapping, as well as the characteristic right precordial ECG findings of the syndrome and its worst manifestation, ventricular fibrillation. Recent investigations have shown that epicardial mapping and ablation to eliminate abnormal electrograms in the RVOT region can normalize the surface ECG findings and prevent many, if not most, episodes of malignant ventricular arrhythmia. This chapter deals with catheter ablation therapy for inherited arrhythmia syndromes, with BS as an example.