An Iatrogenically Unmasked Life Threatening Disease: Brugada Syndrome
A 62-year-old male presented to the emergency department of a local hospital complaining of palpitation. Because emergency department physicians interpreted the ECG as indicating atrial fibrillation, they administered intravenous propafenone (). After this, the patient experienced dizziness and became hypotensive (blood pressure: 80/50 mm Hg). ECG after propafenone infusion showed an RBBB pattern, ST-segment elevation in leads V 1-3 and ST-segment depression in leads DII, DIII and aVF (). He was thus immediately transferred to our center with the diagnosis of acute myocardial infarction. On admission to our center he had palpitation and mild chest pain. Other than the above mentioned characteristics, ECG revealed atrial fibrillation with a ventricular rate of 155/min. The remainder of the physical examination results were within normal limits. We performed coronary angiography, which was normal. Given that he was symptomatic and hypotensive, direct current cardioversion was performed (100 joules). After shock, the ECG was in sinus rhythm and compatible with Brugada syndrome (). After cardioversion, his symptoms subsided and blood pressure returned to within the normal range. His transthoracic echocardiography, electrolytes and cardiac enzymes were all normal. ECG changes were in accordance with iatrogenic unmasking of concealed type Brugada syndrome. Due to ethical reasons we did not give additional propafenone for challenge. From acquiring detailed history, we learnt that one of his sisters had the diagnosis of Brugada syndrome (). During family screening, we found that his daughter also had the asymptomatic type 2 ECG pattern of Brugada. We recommended him for further electrophysiologic evaluation for possible ventricular arrhythmia detection and risk stratification.