Brugada-type ECG association with unexpected sick sinus syndrome

Area of Science:

• Cardiology
• Electrophysiology
• Medical Diagnostics

Background:

• Atrial flutter ablation is a common procedure for managing supraventricular tachycardias.
• Sinus node dysfunction (SND) can be a complication following cardiac procedures.
• Brugada syndrome is a genetic disorder affecting the heart's electrical system.

Observation:

• A 23-year-old man underwent atrial flutter ablation.
• Post-ablation, persistent sinus node dysfunction was observed despite a 2-month drug-free period.
• Secondary causes for SND were ruled out.
• Electrocardiogram (ECG) showed coved-type ST elevation in leads V1-V3.
• Flecainide challenge exacerbated the ST elevation, indicative of Brugada-type patterns.

Findings:

• The case highlights an unexpected association between atrial flutter ablation and the unmasking of Brugada-type ECG changes.
• Persistent sinus node dysfunction following ablation, in conjunction with Brugada-type ECG, suggests a potential link or co-occurrence.
• Flecainide provocation test is crucial in unmasking latent Brugada patterns.

Implications:

• Clinicians should consider Brugada syndrome in patients presenting with sinus node dysfunction post-ablation, especially with suggestive ECG findings.
• Further investigation into the relationship between ablation procedures and Brugada syndrome is warranted.
• This case emphasizes the importance of comprehensive ECG evaluation and provocative testing in diagnosing cardiac electrical disorders.