Monomorphic Ventricular Tachycardia in Patients with Brugada Syndrome: A Multicenter Retrospective Study.

Isolated cases of monomorphic ventricular tachycardia (MVT) in patients with Brugada syndrome (BrS) have been reported.We aimed to describe the incidence and characteristics of MVT in a cohort of BrS patients who had received an implantable cardioverter defibrillator (ICD).Data from 834 BrS patients with an ICD in 15 tertiary hospitals between 1993 and 2014 were included.Mean age was 45.3 ± 13.9; 200 patients (24%) were women. During a mean follow-up of 69.4 ± 54.3 months, 114 patients (13.7%) experienced at least one appropriate ICD intervention, with MVT recorded in 35 patients (4.2%) (sensitive to antitachycardia pacing in 15 (42,8%)). Only QRS width was an independent predictor of MVT in the overall population. Specifically, 6 patients presented with right ventricular outflow tract tachycardia (RVOT) (successfully ablated from the endocardium in 4 and epi + endocardial ablation in one), two patients with MVT arising from the left ventricle (LV) (one successfully ablated in the supra lateral mitral annulus) and two patients with bundle branch reentry VT (BBRVT). Significant structural heart disease was ruled out by echocardiography and/or CMR.In this retrospective study, 4.2% of the patients with BrS implanted with an ICD presented with MVT confirmed as arising from the RVOT in 6, the LV in 2 and BBRVT in 2. Endocardial +/- epicardial ablation was successful in 80% of these cases. These data imply that the occurrence of MVT should not rule out the possibility of BrS. This finding may also be relevant for ICD model selection and programming.