B-PO02-216 MONOMORPHIC VENTRICULAR TACHYCARDIA FOLLOWING VENTRICULAR FIBRILLATION ABLATION IN BRUGADA SYNDROME

Abstract

Radiofrequency (RF) epicardial RV/RV outflow tract (RVOT) substrate ablation can normalize Brugada pattern ECG & reduce Ventricular Fibrillation (VF) recurrence. There is no of literature about proarrhythmic effect of ablation and scar creation. Case of monomorphic Ventricular Tachycardia (MM VT) after VF ablation for Brugada Syndrome due to ablation induced scar related re-entry. NA 47-year-old male with Brugada syndrome diagnosed after sudden cardiac death & confirmed with SCN5A gene mutation had multiple ICD therapies for VF despite high dose oral Quinidine. Cardiac MRI showed structurally normal heart & absence of scar. He underwent VF ablation where epicardial surface & endocardial RV was mapped. RV endocardium was normal. Epicardial voltage map showed area of low voltage with late potentials over anterior RVOT. IV Procainamide resulted in expansion of low voltage area. RF ablation & homogenization of this area was performed. Post procedure normalization of ECG was noted at 3 months. He did not have ICD therapies for 1 year & quinidine was tapered with no anterior precordial ECG abnormalities. 1.5 years post ablation he had presyncope & sustained MM VT. ICD intracardiac electrograms showed MM VT, stable cycle length of 250ms. Anti-tachycardia pacing terminated VT. Far field EGM morphology suggested an inferiorly directed VT. Quinidine was restarted at low dose with no recurrent arrhythmias. Documented case of monomorphic VT post epicardial substrate modification for VF in Brugada syndrome. Scar created by RF ablation on epicardial RVOT may contribute to re-entrant VT via incomplete ablation or iatrogenic scar mediated reentry.