Arrhythmogenic Substrate Ablation in a Patient With Brugada Syndrome and Electrical Storm

Abstract Despite being a rare condition, Brugada syndrome (BrS) poses a significant risk of arrhythmic death, and managing associated ventricular arrhythmias is particularly challenging. Here, we present a case where percutaneous ablation targeted an arrhythmogenic substrate in a patient with BrS and recurrent ventricular fibrillation (VF). Epicardial mapping revealed abnormal potential areas in the right ventricle's outflow tract and free wall. Injection of warmed saline into the pericardial space caused further delay in local electrograms and expanded the abnormal potential area. Radiofrequency applications in this region successfully eliminated abnormal electrograms, leading to the disappearance of the coved-shape ST-segment elevation in leads V1-V2. No recurrence of ventricular arrhythmias was reported in a twelve-month follow-up.