Introduction: Brugada syndrome (BrS) is an inherited disease characterized by an increased risk of sudden cardiac death (SCD). Therapeutic options in symptomatic patients are limited to implantable cardioverter defibrillator (ICD) and quinidine, but catheter ablation of the right ventricular outflow tract (RVOT) offers a potential cure. Different ablation strategies have been used to treat patients with symptomatic Brugada syndrome. Epicardial radiofrequency substrate ablation of the RVOT/right ventricle (RV) has emerged as a promising tool for the management of the disease.Areas covered: The historical management of BrS, endocardial and epicardial ablation techniques, the use of sodium channel blockers (SCB) and complications are summarized here.Expert opinion: Ventricular fibrillation (VF)-triggering premature ventricular contractions (PVCs) in patients with BrS are unpredictable, spontaneous ones are rarely present to be mapped, making this approach impractical. Furthermore, endocardial mapping for BrS substrates does not seem effective due to the epicardial pathological substrate localization. The size variation of the BrS substrate areas during SCB infusion suggests a dynamic process as arrhythmogenic basis and SCB infusion should guide BrS epicardial ablation of all abnormal potentials areas. If BrS epicardial ablation can truly provide long-term prevention of ventricular arrhythmias it may potentially become an alternative to ICD therapy.

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简介: Brugada综合征 (BrS) 是一种遗传性疾病,其特征是心脏性猝死 (SCD) 的风险增加。有症状患者的治疗选择仅限于植入式心律转复除颤器 (ICD) 和奎尼丁,但右心室流出道导管消融 (RVOT) 可提供潜在的治愈方法。已使用不同的消融策略来治疗有症状的Brugada综合征患者。心外膜射频基底消融RVOT/右心室 (RV) 已成为治疗该疾病的有前途的工具。涵盖的领域: BrS的历史管理,心内膜和心外膜消融技术,钠通道阻滞剂 (SCB) 的使用和并发症在这里进行总结。专家意见: brS患者的心室纤颤 (VF) 触发室性早搏 (PVCs) 是不可预测的,自发的很少出现,因此这种方法不切实际。此外,由于心外膜病理底物的定位,BrS底物的心内膜定位似乎无效。SCB输注过程中BrS底物区域的大小变化表明动态过程是心律失常的基础,SCB输注应指导BrS心外膜消融所有异常电位区域。如果BrS心外膜消融可以真正提供长期预防室性心律失常,则可能成为ICD疗法的替代方法。

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