Accelerated idioventricular rhythm unmasking the brugada electrocardiographic pattern
Marcelo V Elizari1, Diego Conde, Adrian Baranchuk
1Division of Cardiology, Hospital Ramos Mejia, Buenos Aires, Argentina.
Summary
A high-degree right bundle branch block (RBBB) can mask Brugada ECG patterns. Spontaneous rhythm changes in an elderly patient revealed a suspicious Brugada pattern, highlighting diagnostic challenges.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Diagnostics
Background:
- The Brugada ECG pattern is associated with an increased risk of sudden cardiac death.
- High-degree right bundle branch block (RBBB) can obscure other ECG findings.
- Early identification of Brugada syndrome is crucial for timely intervention.
Observation:
- An 82-year-old patient presented with recent onset palpitations.
- Resting ECG revealed sinus rhythm, high-degree RBBB, and irregular idioventricular rhythm.
- Spontaneous fusion beats between sinus and idioventricular rhythms occurred, showing an incomplete RBBB pattern.
Findings:
- The dynamic ECG changes unveiled ST-segment elevation, suggestive of a Brugada ECG pattern.
- The coexistence of high-degree RBBB and Brugada pattern elements was observed.
- This case demonstrates how RBBB can conceal critical Brugada ECG manifestations.
Implications:
- High-degree RBBB necessitates careful ECG monitoring for potential underlying Brugada patterns.
- Diagnostic strategies may need adjustment in patients with coexisting RBBB and suspected Brugada.
- Understanding these complex electrophysiological interactions is vital for accurate diagnosis and patient management.
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