Chauncey Strauss posted an update 5 days, 5 hours ago
A structured inherited arrhythmia (or heart disease) clinic provides the platform for optimized multidisciplinary evaluation and management of patients and families with suspected inherited heart disease. The collective efforts of the core staff and access to a variety of experts in related disciplines will result in improved quality of care, patient satisfaction, and improvement in the appropriate use of diagnostic testing and therapeutic intervention. The promise of such a clinic structure is lower overall cost and improvement in patient outcomes.IntroductionMost idiopathic ventricular arrhythmias (VAs) including ventricular tachycardia (VT) and premature ventricular contractions (PVCs), originate from the right ventricular (RV) outflow tract (RVOT) [1,2]. A few studies have demonstrated idiopathic VAs arising from the para-Hisian region [3–9]. In terms of their electrocardiographic and electrophysiological features, VAs originating from the para-Hisian area are similar to those originating from the RVOT, the coronary cusp adjacent to the membranous septum, or the left ventricular (LV) septum below the aortic valve [4,5,10]. In addition, VAs arising from the posterior wall of the RVOT have a left bundle branch block (LBBB) QRS morphology, with an inferior axis, late precordial transition, and an R wave in lead I—features similar to those of RV para-Hisian VAs. Although the efficacy of radiofrequency catheter ablation (RFCA) in this area is improving, the potential risk of atrioventricular conduction disturbances related to the ablation procedure still exists. Several previous studies have reported the use of cryo A 779 as an alternative energy source in close proximity to the conduction system [11,12]. The purpose of this study was to investigate the prevalence, electrocardiographic and electrophysiological characteristics, and the results of RFCA of VAs originating from the para-Hisian area, in comparison with VAs arising from the posterior wall of RVOT.Material and methodsResultsDiscussionConclusionsIn comparioson with posterior RVOT VAs, VAs arising from the para-Hisian area were characterized by a narrower QRS width, the presence of an R wave in leads I and aVL and a QS wave in lead V1, and a higher R wave amplitude ratio in leads II/III. RF application at the distal bipole of the ablation catheter, which showed His potentials at the proximal bipole, successfully eliminated para-Hisian VAs without causing atrioventricular conduction disturbances.Conflict of interestIntroductionBrugada syndrome (BS) is characterized by ST segment elevation (coved type) in the right precordial electrocardiographic (ECG) leads and sudden cardiac arrest (SCA) or death in patients with normal cardiac structure. The syndrome typically manifests during adulthood, with a mean onset age of 41 years [1,2]. The causes of SCA in BS are polymorphic ventricular tachycardia (VT) and ventricular fibrillation (VF) [1,2].In Thailand and Southeast Asia, the incidence of Brugada ECG type 1 in patients with previous cardiac arrest is higher than that in the general population in Europe and the United States [3,4]. BS accounts for 47.2% of all sudden deaths in Northeastern Thailand and only 4−12% in the rest of the world [3,4]. SCA from VT and VF in BS patients occurs mainly at rest, predominantly during sleep . The typical ECG pattern changes over time and is mediated by post-exercise or pharmacologic interventions that interact with the autonomic nervous system (ANS) . ST segment elevation in leads V1–V3 could be augmented by administration of sodium channel blockers and high intercostal ECG lead placement in patients with suspected BS who are at risk for VT/VF .The implantable cardioverter defibrillator (ICD) is more effective than antiarrhythmic drugs for symptomatic BS patients, including those with aborted SCA and syncope [8,9]. The average mortality rate of BS from recurrent VT/VF may be high as 25% ; therefore, BS is considered the main public health problem in Northeastern Thailand and the Southeast Asian countries. By 2015, the Association of Southeast Asian Nations (ASEAN) Economic Community (AEC) project will be implemented by all governments in Southeast Asia. This project will allow Southeast Asians to work freely in any country in the region. Increased travel, particularly among workers in ASEAN countries, will occur. SCA was reported in a group of Thai workers in Singapore in the 1990s . Therefore, healthcare personnel in the ASEAN community and Asia should be aware of this fatal condition in the years after 2015. More scientific reports of BS in Asian populations also need to be shared. Herein, we report the clinical outcomes of symptomatic BS patients treated with ICDs.