First case of epicardial ablation to coexistent J waves in the inferior leads in a patient with clinical diagnosis of Brugada syndrome

Introduction It is well established that type 1 Brugada syndrome (BrS) is associated with ventricular fibrillation (VF). Recently, Morita et al suggested in an experimental model that radiofrequency catheter ablation applied to the right ventricular (RV) epicardium might be more effective than radiofrequency ablation applied to the endocardium in order to eliminate ventricular tachycardia in patients with BrS. In addition, Nademanee et al reported that the likely underlying electrophysiological mechanism in patients with BrS was a delayed depolarization involving the anterior epicardial region of the right ventricular outflow tract (RVOT). They also reported that catheter ablation over this abnormal area resulted in normalization of the electrocardiographic (ECG) characteristics of BrS and prevented ventricular tachyarrhythmias. To our knowledge, we describe here the first case report demonstrating extensive epicardial bipolar voltage abnormality in a patient with BrS and coexistent J waves that was modified by ablation with good VF control.