3D-Mapping Challenges in Hybrid Video-Assisted Thoracoscopic Surgical Ablation of Brugada Syndrome.

Abstract

Brugada syndrome (BrS) is a life-threatening disease with an arrhythmogenic substrate located in the epicardium of right ventricle outflow tract (RVOT). Therefore, the correct region identification is crucial for a successful ablation procedure. Various mapping techniques can be adopted to elaborate this issue, but they were all initially developed for endovascular use. In this study we analyzed 21 consecutive hybrid video-assisted thoracoscopic (VATS) ablation of BrS, performed using different mapping systems to identify the ablation target and confirm the elimination of arrhythmogenic substrate; 35 maps have been analyzed. Acute success of epicardial RVOT ablation has been achieved in 100% of procedures, no periprocedural complications have been observed; HD Grid catheter showed higher area identification speed and faster fractionated potentials visualization; Rhythmia system has demonstrated the best map density; Carto3 system showed a significant advantage in patient preparation time, but mapping speed was reduced due to focal catheter use only. All tested electro anatomical mapping systems can be used for hybrid VATS ablation with same clinical success; however, accuracy and efficacy of mapping systems are heterogenous and highly dependent on proper patient preparation, mapping system and physician skills.