Cristian Stătescu Teodor Flaviu Vasilcu Ioana Mădălina Chiorescu Grigore Tinică Cătălina Arsenescu-Georgescu Radu Sascău

Abstract

Brugada syndrome can induce malignant ventricular arrhythmias in the absence of structural heart disease. The hallmark of the condition is the coved (type I) or saddle-back (types II and III) ST segment elevation in the right precordial leads. The definite diagnosis requires the documentation of the type I morphology. The electrocardiographic pattern is often dynamic, but it can be unmasked by sodium channel blockers such as flecainide. We report the case of a 33-year old male, with family history significant for sudden cardiac death, who underwent successful cardio-pulmonary resuscitation for ventricular fibrillation-associated cardiac arrest. The 12 lead electrocardiogram performed after the resuscitation maneuvers showed intermittent type 1 Brugada pattern. General physical examination and routine laboratory evaluation were unremarkable. A repeated electrocardiogram revealed sinus tachycardia with right bundle branch block. We performed a flecainide challenge test which reproduced the initial coved-type ST segment elevation in V1 and V2. We decided to implant a ventricular single chamber cardioverter-defibrillator with one therapeutical window for ventricular fibrillation (at 300 ms), high energy shocks without antitachycardia pacing. The device was successful in preventing another episode of ventricular fibrillation just 2 days after the procedure. Implantable cardioverter-defibrillators are the most effective secondary prophylaxis therapeutic options for individuals with Brugada Syndrome, but they subject the patient to complications related to device implantation and inappropriate shocks.

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Keywords

Brugada syndrome, implantable cardioverter defibrillator, flecainide test, ventricular fibrillation

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How to Cite
Stătescu, C., Vasilcu, T. F., Chiorescu, I. M., Tinică, G., Arsenescu-Georgescu, C., & Sascău, R. (2017). Optimal management of Brugada syndrome. Archive of Clinical Cases, 4(2), Arch Clin Cases 2017; 4(2):67-73. https://doi.org/10.22551/2017.15.0402.10096
Section
Case Reports

How to Cite

Stătescu, C., Vasilcu, T. F., Chiorescu, I. M., Tinică, G., Arsenescu-Georgescu, C., & Sascău, R. (2017). Optimal management of Brugada syndrome. Archive of Clinical Cases, 4(2), Arch Clin Cases 2017; 4(2):67-73. https://doi.org/10.22551/2017.15.0402.10096