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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 39-year-old man with Brugada syndrome &#40;BS&#41; and recurrent arrhythmia storms &#40;nearly once a month&#41; due to ventricular fibrillation &#40;VF&#41; resistant to maximum tolerated doses of quinidine was referred for catheter ablation in our center&#46; His heart was structurally normal&#44; with normal left and right ventricular systolic function and no chamber dilatation or ventricular wall motion abnormalities on recent echocardiographic assessment or MRI performed some years before&#46; He had received an implantable cardioverter-defibrillator following an episode of out-of-hospital ventricular fibrillation&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient presented with spontaneous type 1 pattern at the start of the procedure &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#41;&#44; and both endocardial and epicardial access was obtained&#46; The Rhythmia&#8482; mapping system &#40;Boston Scientific<span class="elsevierStyleSup">&#169;</span>&#44; MA&#44; USA&#41; was used&#44; and after mapping with the Intellamap Orion&#8482; catheter &#40;Boston Scientific<span class="elsevierStyleSup">&#169;</span>&#44; MA&#44; USA&#41;&#44; fractionated potentials were targeted using the Intellanav&#8482; open-irrigated catheter &#40;Biosense Webster<span class="elsevierStyleSup">&#169;</span>&#44; CA&#44; USA&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C&#41;&#46; Some fractionated potentials were found in the right ventricular outflow tract &#40;RVOT&#41; endocardium &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D&#41;&#44; but longer potentials&#44; measuring &#62;200 to 300<span class="elsevierStyleHsp" style=""></span>ms&#44; were observed&#44; mostly in the epicardial layer &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>E&#41; &#40;potential duration was measured from start to end of the local electrogram using the method described by Pappone et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a>&#41;&#46; Interestingly&#44; areas of scar were also detected in the RVOT endocardium and epicardium &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C and D&#41;&#46; Following ablation in the area &#40;40<span class="elsevierStyleHsp" style=""></span>W&#44; 30 s per lesion until eradication of the long-duration potentials&#41;&#44; the coved type 1 pattern disappeared&#46; After nine months of follow-up&#44; and no recurrence of the coved type 1 pattern &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#41;&#44; the patient had a single episode of VF in the second month&#44; and is now free from anti-arrhythmic drugs&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">This first case of BS ablation using the Rhythmia&#8482; mapping system illustrates three important points&#46; Firstly&#44; fibrosis can also be present in some individuals with BS who do not meet criteria for arrhythmogenic right ventricular dysplasia&#46; This had been suggested by Coronel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> Whether fibrosis results from a more aggressive form of channelopathy in which channel dysfunction leads to tissue changes&#44; additional mutations or polymorphisms in different genes&#44; or modulators leading to fibrosis&#44; or from a coincidental occurrence of localized myocarditis&#44; remains to be determined&#46; In this case no mutation or polymorphism could be identified&#44; and therefore we cannot provide data to support the above hypothesis&#46; However&#44; a recent publication suggests that BS patients with <span class="elsevierStyleItalic">SCN5A</span> mutations may exhibit more conduction abnormalities on the electrocardiogram and be at higher risk for cardiac events&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> Nademanee et al&#46; have shown that increased collagen&#44; fibrosis and reduced gap junction signaling protein Cx43 expression in the RVOT are present in BS patients&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> These data support the plausibility of BS reflecting a generalized disease of myocardial architecture&#44; and the baseline properties of the RVOT which predispose it to fibrosis are likely to contribute to the condition and its arrhythmic risk&#46; The presence of coexistent fibrosis may explain why up to 5&#37; of BS patients may also develop monomorphic ventricular tachycardias&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> Secondly&#44; our findings of fractionated potentials in the endocardium &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D&#41; suggest there may still be a rationale for seeking ventricular ectopics originating from the area or for ablating long-duration endocardial potentials&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> In our case&#44; as these potentials were only identified on retrospective analysis of the map and were therefore not ablated&#44; we cannot help but wonder if the preservation of this zone is the reason why the patient relapsed&#46; A recent investigation using simultaneous non-invasive mapping of the endocardium and epicardium suggests that both appear to be involved in a substantial number of patients&#44; and their interplay appears to play a role in the observed phenotype&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> Also&#44; in our case&#44; prolonged endocardial electrograms were located in the low posteroseptal region of the RVOT&#44; which is not the traditional area of epicardial involvement in BS&#46; Thirdly&#44; disappearance of the coved pattern does not necessarily predict cure&#46; In this case we hypothesize that several factors may have contributed to VF recurrence&#44; including the existence of an underlying fibrotic substrate &#40;which may have been aggravated with ablation&#41; and a low transmyocardial repolarization gradient which was insufficient to result in a coved type 1 pattern&#44; but in the presence of an appropriately timed ventricular ectopic was still sufficient to degenerate into VF&#46; Finally&#44; much remains to be learned about BS&#44; and the growing number of catheter ablations for this disease will certainly help expand our knowledge&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The high-density mapping capabilities of the Rhythmia&#8482; mapping system are advantageous in this setting as very precise mapping&#44; with no limit to the number of collected points&#44; and identification of the culprit potentials is likely to have an impact on procedural success and prognosis in these patients&#46; Furthermore&#44; if the future of mapping in this condition is to follow the approach used by Pappone et al&#46;&#44; <a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> in which mapping is repeated following ablation and repeated ajmaline infusion&#44; the ultra-rapid mapping potential of the Rhythmia&#8482; system will make it a likely candidate in this setting&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">With regard to the use of this system in the epicardium&#44; we created a shell comprising two layers&#44; one corresponding to the visceral epicardium adjacent to the myocardium&#44; and the other to the parietal pericardium&#46; The analysis presented in these images is only of the visceral epicardium&#44; as we excluded the outer layer of the shell&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The definition that can be obtained with high-density mapping is very different from that of point-by-point mapping using other mapping systems&#46; For example&#44; our epicardial map was composed of 50&#160;472 electrograms&#44; which is &#62;<span class="elsevierStyleHsp" style=""></span>100 times more detailed than was described in a previous case report&#44; in which only 304 points were collected&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> Unfortunately&#44; unlike ours&#44; this case&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> which displayed a right bundle branch block pattern at baseline&#44; and the presence of Brugada pattern in the right precordial and also in the inferior limb leads&#44; did not present follow-up data beyond six weeks&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In our case&#44; we did not perform post-ablation ajmaline testing or programmed ventricular stimulation&#46; The controversy regarding programmed ventricular stimulation in the setting of risk assessment has lasted for decades&#46; Even though it has been used by some authors&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;8</span></a> its role as a predictor of success of catheter ablation is still open to debate&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Ethical disclosures</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Protection of human and animal subjects</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Confidentiality of data</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Right to privacy and informed consent</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The authors report the first catheter ablation of Brugada syndrome in the literature using the Rhythmia&#8482; mapping system&#46; Learning points include&#58; &#40;1&#41; low voltage areas can be documented while mapping in some individuals&#44; suggesting that Brugada syndrome may not be a pure ion channel disorder&#59; &#40;2&#41; typical long fractionated potentials can also be identified in the endocardium&#44; supporting the need to map the endocardium in all Brugada patients requiring ablation&#59; &#40;3&#41; disappearance of the typical coved pattern following ablation does not necessarily predict cure&#44; as the patient we present experienced ventricular fibrillation recurrence a few months later&#46;</p></span>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A and B&#41; Precordial leads &#40;V1 to V3&#41; showing presence of spontaneous type 1 Brugada pattern at the start of the procedure&#44; and its disappearance nine months later&#59; &#40;C&#41; epicardial voltage map of the right ventricle using the Rhythmia&#8482; mapping system&#44; anteroposterior view with 0&#46;5 and 1&#46;5<span class="elsevierStyleHsp" style=""></span>mV as voltage cut-off points&#44; showing large areas of fibrosis in the right ventricular outflow tract &#40;RVOT&#41; and anterior wall of the right ventricle&#59; &#40;D&#41; endocardial voltage map of the right ventricle&#44; posteroanterior view&#44; showing an area of fibrosis in the posteroseptal aspect of the RVOT&#46; A long &#40;&#62;120<span class="elsevierStyleHsp" style=""></span>ms&#41;&#44; complex&#44; small-amplitude and fractionated potential is highlighted&#59; &#40;E&#41; potential duration map of the epicardial aspect of the right ventricle&#44; anteroposterior view&#44; showing area of potentials lasting more than 291<span class="elsevierStyleHsp" style=""></span>ms &#40;purple&#41;&#44; corresponding to the ablated zone&#46; Areas of potentials lasting less than 200<span class="elsevierStyleHsp" style=""></span>ms are in red&#46; Highlighted is a very long and complex potential measuring approximately 371<span class="elsevierStyleHsp" style=""></span>ms&#46; PA&#58; pulmonary artery&#59; TV&#59; tricuspid valve&#46;</p>"
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                    0 => array:2 [
                      "titulo" => "Electrical substrate elimination in 135 consecutive patients with Brugada Syndrome"
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              "etiqueta" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Right ventricular fibrosis and conduction delay in a patient with clinical signs of Brugada syndrome&#46; A combined electrophysiological&#44; genetic&#44; histopathologic&#44; and computational study"
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                        "tituloSerie" => "Circulation"
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                        "paginaFinal" => "2777"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16267250"
                            "web" => "Medline"
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                  ]
                ]
              ]
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                0 => array:2 [
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                        0 => array:2 [
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                            2 => "T&#46; Aiba"
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                    ]
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28341781"
                            "web" => "Medline"
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                      ]
                    ]
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                ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fibrosis&#44; connexin-43&#44; and conduction abnormalities in the Brugada syndrome"
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                          "autores" => array:3 [
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                      ]
                    ]
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                        "tituloSerie" => "J Am Coll Cardiol&#46;"
                        "fecha" => "2015"
                        "volumen" => "66"
                        "paginaInicial" => "1976"
                        "paginaFinal" => "1986"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26516000"
                            "web" => "Medline"
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                  ]
                ]
              ]
            ]
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              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Monomorphic ventricular tachycardia in patients with Brugada syndrome&#58; a multicentre retrospective study"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.hrthm.2015.11.039"
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart Rhythm"
                        "fecha" => "2016"
                        "volumen" => "13"
                        "paginaInicial" => "683"
                        "paginaFinal" => "685"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26632641"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
            ]
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              "identificador" => "bib0070"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mapping and ablation of ventricular fibrillation associated with long-QT and Brugada syndromes"
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                      ]
                    ]
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                        "paginaFinal" => "928"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12925452"
                            "web" => "Medline"
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                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Simultaneous non-invasive epicardial and endocardial mapping in patients with Brugada syndrome&#58; new insights into arrhythmia mechanisms"
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                        0 => array:2 [
                          "etal" => true
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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                        "link" => array:1 [
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Case report
Brugada syndrome is associated with scar and endocardial involvement: Insights from high-density mapping with the Rhythmia™ mapping system
Síndrome de Brugada associada com baixa voltagem e envolvimento endocárdico: achados de um mapeamento de alta densidade com o sistema Rhythmia™
Rui Providênciaa,b,
Autor para correspondência
rui_providencia@yahoo.com

Corresponding author.
, Pedro Carmoa, Francisco Moscoso Costaa, Diogo Cavacoa, Francisco Morgadoa, Mauricio Scanavaccac, Pedro Adragãoa
a Department of Cardiology, Santa Cruz Hospital, CHLO, Carnaxide, Portugal
b St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
c Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 39-year-old man with Brugada syndrome &#40;BS&#41; and recurrent arrhythmia storms &#40;nearly once a month&#41; due to ventricular fibrillation &#40;VF&#41; resistant to maximum tolerated doses of quinidine was referred for catheter ablation in our center&#46; His heart was structurally normal&#44; with normal left and right ventricular systolic function and no chamber dilatation or ventricular wall motion abnormalities on recent echocardiographic assessment or MRI performed some years before&#46; He had received an implantable cardioverter-defibrillator following an episode of out-of-hospital ventricular fibrillation&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient presented with spontaneous type 1 pattern at the start of the procedure &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#41;&#44; and both endocardial and epicardial access was obtained&#46; The Rhythmia&#8482; mapping system &#40;Boston Scientific<span class="elsevierStyleSup">&#169;</span>&#44; MA&#44; USA&#41; was used&#44; and after mapping with the Intellamap Orion&#8482; catheter &#40;Boston Scientific<span class="elsevierStyleSup">&#169;</span>&#44; MA&#44; USA&#41;&#44; fractionated potentials were targeted using the Intellanav&#8482; open-irrigated catheter &#40;Biosense Webster<span class="elsevierStyleSup">&#169;</span>&#44; CA&#44; USA&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C&#41;&#46; Some fractionated potentials were found in the right ventricular outflow tract &#40;RVOT&#41; endocardium &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D&#41;&#44; but longer potentials&#44; measuring &#62;200 to 300<span class="elsevierStyleHsp" style=""></span>ms&#44; were observed&#44; mostly in the epicardial layer &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>E&#41; &#40;potential duration was measured from start to end of the local electrogram using the method described by Pappone et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a>&#41;&#46; Interestingly&#44; areas of scar were also detected in the RVOT endocardium and epicardium &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C and D&#41;&#46; Following ablation in the area &#40;40<span class="elsevierStyleHsp" style=""></span>W&#44; 30 s per lesion until eradication of the long-duration potentials&#41;&#44; the coved type 1 pattern disappeared&#46; After nine months of follow-up&#44; and no recurrence of the coved type 1 pattern &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#41;&#44; the patient had a single episode of VF in the second month&#44; and is now free from anti-arrhythmic drugs&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">This first case of BS ablation using the Rhythmia&#8482; mapping system illustrates three important points&#46; Firstly&#44; fibrosis can also be present in some individuals with BS who do not meet criteria for arrhythmogenic right ventricular dysplasia&#46; This had been suggested by Coronel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> Whether fibrosis results from a more aggressive form of channelopathy in which channel dysfunction leads to tissue changes&#44; additional mutations or polymorphisms in different genes&#44; or modulators leading to fibrosis&#44; or from a coincidental occurrence of localized myocarditis&#44; remains to be determined&#46; In this case no mutation or polymorphism could be identified&#44; and therefore we cannot provide data to support the above hypothesis&#46; However&#44; a recent publication suggests that BS patients with <span class="elsevierStyleItalic">SCN5A</span> mutations may exhibit more conduction abnormalities on the electrocardiogram and be at higher risk for cardiac events&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> Nademanee et al&#46; have shown that increased collagen&#44; fibrosis and reduced gap junction signaling protein Cx43 expression in the RVOT are present in BS patients&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> These data support the plausibility of BS reflecting a generalized disease of myocardial architecture&#44; and the baseline properties of the RVOT which predispose it to fibrosis are likely to contribute to the condition and its arrhythmic risk&#46; The presence of coexistent fibrosis may explain why up to 5&#37; of BS patients may also develop monomorphic ventricular tachycardias&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> Secondly&#44; our findings of fractionated potentials in the endocardium &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D&#41; suggest there may still be a rationale for seeking ventricular ectopics originating from the area or for ablating long-duration endocardial potentials&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> In our case&#44; as these potentials were only identified on retrospective analysis of the map and were therefore not ablated&#44; we cannot help but wonder if the preservation of this zone is the reason why the patient relapsed&#46; A recent investigation using simultaneous non-invasive mapping of the endocardium and epicardium suggests that both appear to be involved in a substantial number of patients&#44; and their interplay appears to play a role in the observed phenotype&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> Also&#44; in our case&#44; prolonged endocardial electrograms were located in the low posteroseptal region of the RVOT&#44; which is not the traditional area of epicardial involvement in BS&#46; Thirdly&#44; disappearance of the coved pattern does not necessarily predict cure&#46; In this case we hypothesize that several factors may have contributed to VF recurrence&#44; including the existence of an underlying fibrotic substrate &#40;which may have been aggravated with ablation&#41; and a low transmyocardial repolarization gradient which was insufficient to result in a coved type 1 pattern&#44; but in the presence of an appropriately timed ventricular ectopic was still sufficient to degenerate into VF&#46; Finally&#44; much remains to be learned about BS&#44; and the growing number of catheter ablations for this disease will certainly help expand our knowledge&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The high-density mapping capabilities of the Rhythmia&#8482; mapping system are advantageous in this setting as very precise mapping&#44; with no limit to the number of collected points&#44; and identification of the culprit potentials is likely to have an impact on procedural success and prognosis in these patients&#46; Furthermore&#44; if the future of mapping in this condition is to follow the approach used by Pappone et al&#46;&#44; <a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> in which mapping is repeated following ablation and repeated ajmaline infusion&#44; the ultra-rapid mapping potential of the Rhythmia&#8482; system will make it a likely candidate in this setting&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">With regard to the use of this system in the epicardium&#44; we created a shell comprising two layers&#44; one corresponding to the visceral epicardium adjacent to the myocardium&#44; and the other to the parietal pericardium&#46; The analysis presented in these images is only of the visceral epicardium&#44; as we excluded the outer layer of the shell&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The definition that can be obtained with high-density mapping is very different from that of point-by-point mapping using other mapping systems&#46; For example&#44; our epicardial map was composed of 50&#160;472 electrograms&#44; which is &#62;<span class="elsevierStyleHsp" style=""></span>100 times more detailed than was described in a previous case report&#44; in which only 304 points were collected&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> Unfortunately&#44; unlike ours&#44; this case&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> which displayed a right bundle branch block pattern at baseline&#44; and the presence of Brugada pattern in the right precordial and also in the inferior limb leads&#44; did not present follow-up data beyond six weeks&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In our case&#44; we did not perform post-ablation ajmaline testing or programmed ventricular stimulation&#46; The controversy regarding programmed ventricular stimulation in the setting of risk assessment has lasted for decades&#46; Even though it has been used by some authors&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;8</span></a> its role as a predictor of success of catheter ablation is still open to debate&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Ethical disclosures</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Protection of human and animal subjects</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Confidentiality of data</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Right to privacy and informed consent</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The authors report the first catheter ablation of Brugada syndrome in the literature using the Rhythmia&#8482; mapping system&#46; Learning points include&#58; &#40;1&#41; low voltage areas can be documented while mapping in some individuals&#44; suggesting that Brugada syndrome may not be a pure ion channel disorder&#59; &#40;2&#41; typical long fractionated potentials can also be identified in the endocardium&#44; supporting the need to map the endocardium in all Brugada patients requiring ablation&#59; &#40;3&#41; disappearance of the typical coved pattern following ablation does not necessarily predict cure&#44; as the patient we present experienced ventricular fibrillation recurrence a few months later&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Os autores descrevem a primeira abla&#231;&#227;o de s&#237;ndrome de Brugada usando o sistema de mapeamento Rhythmia&#8482;&#46; Pontos de aprendizagem incluem&#58; 1&#41; &#233; poss&#237;vel observar fibrose ao mapear alguns destes indiv&#237;duos&#44; sugerindo que a s&#237;ndrome de Brugada poder&#225; n&#227;o ser uma canalopatia pura&#59; 2&#41; os potenciais fracionados de longa dura&#231;&#227;o tamb&#233;m podem ser identificados no endoc&#225;rdio&#44; refor&#231;ando a necessidade de mapeamento tamb&#233;m do endoc&#225;rdio em todos os doentes com Brugada com indica&#231;&#227;o para abla&#231;&#227;o&#59; 3&#41; desaparecimento do padr&#227;o t&#237;pico <span class="elsevierStyleItalic">coved</span> n&#227;o prev&#234; necessariamente a cura&#44; uma vez que no caso apresentado uma recidiva de fibrilha&#231;&#227;o ventricular foi observada alguns meses mais tarde&#46;</p></span>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A and B&#41; Precordial leads &#40;V1 to V3&#41; showing presence of spontaneous type 1 Brugada pattern at the start of the procedure&#44; and its disappearance nine months later&#59; &#40;C&#41; epicardial voltage map of the right ventricle using the Rhythmia&#8482; mapping system&#44; anteroposterior view with 0&#46;5 and 1&#46;5<span class="elsevierStyleHsp" style=""></span>mV as voltage cut-off points&#44; showing large areas of fibrosis in the right ventricular outflow tract &#40;RVOT&#41; and anterior wall of the right ventricle&#59; &#40;D&#41; endocardial voltage map of the right ventricle&#44; posteroanterior view&#44; showing an area of fibrosis in the posteroseptal aspect of the RVOT&#46; A long &#40;&#62;120<span class="elsevierStyleHsp" style=""></span>ms&#41;&#44; complex&#44; small-amplitude and fractionated potential is highlighted&#59; &#40;E&#41; potential duration map of the epicardial aspect of the right ventricle&#44; anteroposterior view&#44; showing area of potentials lasting more than 291<span class="elsevierStyleHsp" style=""></span>ms &#40;purple&#41;&#44; corresponding to the ablated zone&#46; Areas of potentials lasting less than 200<span class="elsevierStyleHsp" style=""></span>ms are in red&#46; Highlighted is a very long and complex potential measuring approximately 371<span class="elsevierStyleHsp" style=""></span>ms&#46; PA&#58; pulmonary artery&#59; TV&#59; tricuspid valve&#46;</p>"
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                    0 => array:2 [
                      "titulo" => "Electrical substrate elimination in 135 consecutive patients with Brugada Syndrome"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Right ventricular fibrosis and conduction delay in a patient with clinical signs of Brugada syndrome&#46; A combined electrophysiological&#44; genetic&#44; histopathologic&#44; and computational study"
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                      "doi" => "10.1161/CIRCULATIONAHA.105.532614"
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                        "tituloSerie" => "Circulation"
                        "fecha" => "2005"
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                        "paginaInicial" => "2769"
                        "paginaFinal" => "2777"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16267250"
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                      ]
                    ]
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                        "tituloSerie" => "J Am Coll Cardiol&#46;"
                        "fecha" => "2015"
                        "volumen" => "66"
                        "paginaInicial" => "1976"
                        "paginaFinal" => "1986"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26516000"
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                        "tituloSerie" => "Heart Rhythm"
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                        "volumen" => "13"
                        "paginaInicial" => "683"
                        "paginaFinal" => "685"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Mapping and ablation of ventricular fibrillation associated with long-QT and Brugada syndromes"
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                      "doi" => "10.1161/01.CIR.0000088781.99943.95"
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                        "tituloSerie" => "Circulation"
                        "fecha" => "2003"
                        "volumen" => "108"
                        "paginaInicial" => "925"
                        "paginaFinal" => "928"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12925452"
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                0 => array:2 [
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                    0 => array:2 [
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                        0 => array:2 [
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                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "J Am Heart Assoc&#46;"
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                        "link" => array:1 [
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                ]
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Revista Portuguesa de Cardiologia
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Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

Ao assinalar que é «Profissional de Saúde», declara conhecer e aceitar que a responsável pelo tratamento dos dados pessoais dos utilizadores da página de internet da Revista Portuguesa de Cardiologia (RPC), é esta entidade, com sede no Campo Grande, n.º 28, 13.º, 1700-093 Lisboa, com os telefones 217 970 685 e 217 817 630, fax 217 931 095 e com o endereço de correio eletrónico revista@spc.pt. Declaro para todos os fins, que assumo inteira responsabilidade pela veracidade e exatidão da afirmação aqui fornecida.