Efficacy of Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation Patients With a Brugada Electrocardiogram

Takumi Yamada; Yukihiko Yoshida; Naoya Tsuboi; Yoshimasa Murakami; Taro Okada; Hugh T. McElderry; Naoki Yoshida; Harish Doppalapudi; Andrew E. Epstein; Vance J. Plumb; Yasuya Inden; Toyoaki Murohara; G. Neal Kay

doi:10.1253/circj.72.281

Clinical Investigation

Efficacy of Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation Patients With a Brugada Electrocardiogram

Takumi Yamada, Yukihiko Yoshida, Naoya Tsuboi, Yoshimasa Murakami, Taro Okada, Hugh T. McElderry, Naoki Yoshida, Harish Doppalapudi, Andrew E. Epstein, Vance J. Plumb, Yasuya Inden, Toyoaki Murohara, G. Neal Kay

Author information

Takumi Yamada
Division of Cardiovascular Diseases, University of Alabama at Birmingham
Yukihiko Yoshida
Division of Cardiology, Nagoya Daini Red Cross Hospital, Cardiovascular Center
Naoya Tsuboi
Division of Cardiology, Chukyo Hospital
Yoshimasa Murakami
Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center
Taro Okada
Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center
Hugh T. McElderry
Division of Cardiovascular Diseases, University of Alabama at Birmingham
Naoki Yoshida
Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center
Harish Doppalapudi
Division of Cardiovascular Diseases, University of Alabama at Birmingham
Andrew E. Epstein
Division of Cardiovascular Diseases, University of Alabama at Birmingham
Vance J. Plumb
Division of Cardiovascular Diseases, University of Alabama at Birmingham
Yasuya Inden
Department of Cardiology, Nagoya University Graduate School of Medicine
Toyoaki Murohara
Department of Cardiology, Nagoya University Graduate School of Medicine
G. Neal Kay
Division of Cardiovascular Diseases, University of Alabama at Birmingham

Keywords: Atrial fibrillation, Brugada syndrome, Electrocardiogram, Pulmonary vein isolation, Radiofrequency catheter ablation

JOURNAL FREE ACCESS

2008 Volume 72 Issue 2 Pages 281-286

DOI https://doi.org/10.1253/circj.72.281

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Abstract

Background Medical therapy of atrial fibrillation (AF) can be challenging in patients with Brugada electrocardiograms (ECGs). The purpose of this study was to investigate the efficacy of pulmonary vein (PV) isolation (PVI) in AF patients with Brugada ECGs. Methods and Results PVI was performed in 6 consecutive patients exhibiting Brugada ECGs (type I in 1, type II in 4, and type III in 1) at baseline. In all patients exhibiting type II or III Brugada ECGs but 1, the administration of sodium-channel blockers converted those ECG patterns to a type I. Five of 6 (83%) patients were free of symptomatic AF without any antiarrhythmic drugs after the first procedure. In the 1 remaining patient with AF recurrence and newly developed atrial tachycardia (AT), the residual conduction gaps of the 3 previously isolated PVs and a focal AT originating from the mitral isthmus were eliminated in the 2^nd session. Finally, during the follow-up period (11±6 months) after the last procedure, all patients were free of any symptomatic atrial arrhythmias without any antiarrhythmic drugs. No other complications occurred. Conclusions Because of the concerns of proarrhythmias with antiarrhythmic drugs, PVI may be an effective strategy for highly symptomatic patients with AF who have a Brugada ECG pattern. (Circ J 2008; 72: 281 - 286)

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