[Arrhythmic storm in a patient with Brugada syndrome--an unusual case]

Brugada syndrome is characterized by episodes of near sudden death or syncope. The heart is normal on physical, angiographic and echocardiographic examination. The characteristic ECG abnormalities consist of ST-segment elevation in leads V1-V3 and pseudo right bundle branch block. The ECG changes can be transient, causing the diagnosis to be missed. Provocative testing with Flecainide or other sodium channel blocking drugs can be used to unmask the ECG abnormalities. This is a case study of a young male who had been diagnosed as suffering from Brugada syndrome and had a defibrillator implanted five years ago. This time the patient was admitted because of syncope and documented an arrhythmic storm (seven episodes of ventricular fibrillation, treated with the implanted defibrillator). The episode occurred following extreme anger and an "exciting event", evoking sympathetic activity. The issue of a different form of autonomic modulation: involving sodium channels' activity in the heart (sympathetic rather than vagal) is raised.