Abstract 18008: Clinical Characteristics, VF Triggers and Substrates, and Catheter Ablation of Patients with Early Repolarization Syndrome with Frequent Recurrent VF Episodes
We describe mapping and ablation (Abl) of VF substrates (Subs) or VF triggers in early repolarization (ER) patients (PTs) with frequent VF episodes.
Method: Eleven ER PTs (all males; median age = 33) were referred for treatment of frequent ICD shocks from VF. ER was characterized by ST elevation in both inferior (Inf) and V4-6 (Lat) leads in 4 PTs, only in the Inf leads in 6 and only in the Lat leads in 1. Brugada (Br) ECG was also present spontaneously in 1 PTs and after ajmaline in 2. All had VF episodes >2 (2-72 episodes). Three PTs had irreversible brain anoxia from refractory VF (one died). The remaining 8 underwent mapping of both ventricles and both endocardium (Endo) and epicardium (Epi) for localization of VF triggers and Subs. Triggers were defined as PVC that initiated VF and VF Subs as late abnormal low-voltage fractionated electrograms, and abnormal Purkinje network (Abn-PJe) that initiated and perpetuated VF.
Results: VF triggers were identified in 2 patients (one from the RV septal Abn-PJe) and the other from LV inferoseptal Abn-PJe; Abl at these sites eliminated VF triggers yielding no VF recurrences. The other 6 patients did not have frequent triggers to be mapped and the Subs mapping was performed. All Pts had inducible VF before Abl. There were no Epi VF Subs in 3 ER Pts (without Br) but had Abn-PJe over the antero-septal ( N=2) and infero-septal (N=1) LV endo; VF induction by PES showed initiation and perpetuation of VF from these Abn-PJe and after Abl at these Abn-PJe sites VF were non-inducible in all 3. The other 3 ER PTs with concomitant Br had abnormal VF Subs over the anterior RVOT Epi and also had Abn-PJe in all 3. For the latter PTs, Abl had to be done both at the anterior RVOT Epi and at the Abn-PJe over the antero-septa LV Endo in 2 PTs to render VF non-inducible and no clinical VF recurrences; whereas the remaining patients with Br needed only Abl over the anterior RVOT Epi to yield non-inducible VF. All PTs were VF free (mean follow-up = 1 year) except one who had one recurrent VF episode (1 month after ablation but VF free afterward [18 months]).
Conclusions: In ER, trigger and initiator of VF are associated with Abn-PJe sites at the septal areas. There were no epicardial Subs unless the presence of concomitant Br. Catheter Abl is effective in treating ER with frequent VF episodes.
- © 2012 by American Heart Association, Inc.