1/6. Spontaneous alternans in Brugada ECG morphology. A 23-year-old man presented with sick sinus syndrome and Brugada-like ECG pattern. Coved type ECG (type 1) converted to saddleback configuration (type 2) when R-R interval decreased and it changed to coved type pattern with increasing R-R cycle length. During stable heart rate, there was no change in Brugada ECG pattern. The R-R interval effect on these patterns can be explained by intensity or kinetics of ion currents and autonomic tone. ( info) |
| Class I antiarrhythmic drug infusion has been established as the standard test to unmask brugada syndrome. This report presents two patients with brugada syndrome with positive flecainide response which was not reproducible in a subsequent test. ( info) |
| A 24-year-old man without structural heart disease was admitted following recurrent syncopes. His baseline ECG revealed a right bundle-branch block (RBBB) pattern. Spontaneous monomorphic and polymorphic ventricular tachycardias (VT) were observed during monitoring.The provocation test by propafenone brought out recurrent spontaneous polymorphic VT and provocation by ajmaline caused an ST elevation in V2. Programmed ventricular stimulation test during the electrophysiologic study revealed both monomorphic and polymorphic VT. The patient received an internal cardioverter/defibrillator with the diagnosis of brugada syndrome. ( info) |
4/6. A case of a concealed type of brugada syndrome with a J wave and mild ST-segment elevation in the inferolateral leads. We report a patient with a concealed type of brugada syndrome. The electrocardiogram in the emergency department revealed atrial fibrillation with an almost normal ST segment. Slight electrocardiogram abnormalities of the J wave and mild ST-segment elevation appeared in the inferolateral leads a few days later. Although the ST segment in the right precordial leads, including that recorded from the high intercostal space recording sites, was completely normal, a drug challenge test using pilsicainide revealed a coved-type ST-segment elevation only in a modified V2 lead placed 1 or 2 intercostal spaces higher. ( info) |
5/6. Brugada-like early repolarisation pattern associated with acute pericarditis. Two cases of acute pericarditis presented with interesting electrocardiograms resembling Brugada-like or early repolarisation patterns. This report emphasises that proper interpretation of the electrocardiogram in patients with ST-segment elevation assists the clinician in arriving at the correct diagnosis in making appropriate diagnostic and therapeutic decisions, and also that the saddleback-type ST-segment elevation cannot be a sensitive finding for the brugada syndrome. ( info) |
6/6. The hyperkalemic Brugada sign. BACKGROUND: A few case reports have indicated that hyperkalemia can induce a Brugada pattern in the electrocardiogram. The specific clinical and electrocardiographic features of the hyperkalemic Brugada sign, however, have not been previously described. methods: A case series was collected from hospitalized hyperkalemic patients with a type I Brugada pattern in the electrocardiogram, and a literature review was performed. Electrocardiograms were examined for rhythm and morphology, and clinical characteristics were analyzed. RESULTS: Nine new cases with the hyperkalemic Brugada sign were identified with an additional 15 cases found in the literature. Of the 9 cases, 8 were male patients, and all were critically ill; 5 of the 9 died within 48 hours. The mean ( /-SD) serum potassium level was 7.8 /- 0.5 mEq/L. The mean QRS width was 144 /- 31 milliseconds, and all had abnormal QRS axis. In 6 cases, there was a wide complex rhythm without visible P waves. The clinical and electrocardiographic characteristics of 15 cases found in the literature were remarkably similar to those in our series. CONCLUSIONS: The hyperkalemic Brugada pattern differs in substantial ways from the electrocardiogram of patients with the genetic brugada syndrome. Many patients have wide complex rhythms without visible P waves, marked QRS widening, and an abnormal QRS axis. Most patients are male, and many are critically ill. Prompt recognition of this clinical and electrocardiographic entity may expedite the initiation of appropriate treatment for hyperkalemia. ( info) |