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- Title
Optimal management of Brugada syndrome.
- Authors
Stătescu, Cristian; Vasilcu, Teodor; Chiorescu, Ioana Mădălina; Tinică, Grigore; Arsenescu-Georgescu, Cătălina; Sascău, Radu
- 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.
- Subjects
BRUGADA syndrome; SYNDROMES; VENTRICULAR fibrillation; HEART diseases; CARDIOVASCULAR diseases
- Publication
Archive of Clinical Cases, 2017, Vol 4, Issue 2, p67
- ISSN
2360-6975
- Publication type
Article
- DOI
10.22551/2017.15.0402.10096