Atrial flutter in normal heart could be first manifestation of Brugada syndrome

Brugada syndrome is one of the important causes of sudden cardiac death in young adults. The condition is associated with typical ECG changes in anteroseptal leads V1 and V2 that can be unmasked by various medications, electrolyte disturbances, and even by fever in susceptible individuals. We here report the case of a 22-year-old female admitted to the emergency room with a typical atrial flutter who developed Brugada-like ECG changes after conversion to sinus rhythm following flecainide infusion with subsequent degeneration in ventricular fibrillation. The patient converted to sinus rhythm after external DC shock intervention. At hospital admission she reported no family history of sudden cardiac death, nor syncope or paroxysmal palpitations. The cardiac echocardiographical exam revealed no structural abnormalities and a normal ejection fraction. This case highlights once more the importance of recognising supraventricular arrhythmias or other rhythm disturbances in young healthy patients as the revealing sign of other underlying pathologies.