Progression of electroanatomic substrate and electric storm recurrence in a patient with Brugada syndrome

In December 2011, a 39-year-old man resuscitated from out-of-hospital cardiac arrest caused by ventricular fibrillation received the diagnosis of Brugada syndrome on the basis of a spontaneous Brugada type 1 ECG pattern (Figure 1A). Before implantation of a cardioverter-defibrillator, the patient, after providing written informed consent, underwent a 3-dimensional electroanatomic mapping of the right ventricle (RV) as part of a clinical research study approved by ethics committee of our institution. A localized low-voltage area with delayed and fragmented potentials was evident in both bipolar and unipolar voltage maps in the anterior RV outflow tract. The patient was discharged with no antiarrhythmic medication and was free of arrhythmic events at implantable cardioverter-defibrillator interrogation for 1 year.