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Type 1 BrS EKG pattern can be unmasked by
anesthesia and vasopressors use.
EKG recognition and proper history are essential for risk stratification of BrS.
Vivek Bhupathi1, Ahmed Ibrahim1, Adriana C. Mares1, Chandra P. Ojha1, Harsha S. Nagarajarao1
1: Division of Cardiovascular Medicine, Paul L Foster School of Medicine ,Texas Tech University Health Sciences Center El Paso,El Paso, Texas, 79905 United States
BACKGROUNDBrugada Syndrome (BrS) is an inherited disorder associated with sudden cardiac arrest (SCA) and sustained ventricular arrhythmias (VA). Risk stratification remains challenging and is based on EKG findings and symptoms.
DECISION MAKINGICD is class I indication in type 1 EKG pattern and history of SCA, VA, unexplained syncope presumed due to VA. Type 2 can be found on serial EKGs on the same patient and can be converted to Type 1 by fever and various drugs. These triggers should be avoided in asymptomatic spontaneous or induced type 1 Br or genetic carrier. EKG lead placement in higher intercostal space can unmask type 1. A positive family history of BrS or SCA is not a significant predictor of adverse events. Genetic testing may be useful to facilitate screening of relatives (Class II b).
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46 year old male presented with fever, jaundice and abdominal pain was found to have biliary sepsis from acute choledocholithiasis. EKG on presentation is shown (Figure 1). During the ERCP done under propofol, he became hypotensive and was started on norepinephrine. Second EKG (Figure 2) showed Type I Brugada pattern. Troponin was negative and an echocardiogram was normal. History was evident for an unexplained syncope 3 months prior. Family history revealed sudden death of his mother at the age 28. Patient got an implantable cardioverter defibrillator (ICD).
CASE
The Incidental Unmasking of Brugada Syndrome
DISCLOSURE INFORMATION
Ahmed Ibrahim: Nothing to disclose.Vivek Bhupathi : Nothing to disclose.
REFERENCES
FIGURE 1
Figure 1: Type 2 Brugada Pattern (previously known as type 3) on admission: >0.5 mm saddle-back shaped ST elevation in 31 right precordial lead (V1>V2).
FIGURE 2
Figure 2: Type 1 Brugada Pattern unmasked by propofol and norepinephrine: ≥ 2 mm J-point elevation, a coved shaped type ST segment elevation and an inverted T-wave in 31 right precordial leads (V1 and V2).
Pappone C, Santinelli V. Brugada Syndrome: Progress in Diagnosis andManagement. Arrhythm Electrophysiol Rev. 2019;8(1):13–18. doi:10.15420/aer.2018.73.2a
1177-334
