A case of anomalous aortic origin of coronary artery associated with a coved-type electrocardiogram
Tsukasa Kamakura1, Laura Cetran1, Frédéric Sacher1
1Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.
Insights
Brugada syndrome (BrS) can mimic ECG changes from coronary artery anomalies. Surgical mapping clarified the cause in a patient with anomalous aortic origin of the coronary artery (AAOCA), guiding treatment.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Surgery
Background:
- Brugada syndrome (BrS) is a genetic disorder associated with sudden cardiac death.
- A Brugada-pattern electrocardiogram (ECG) can also be caused by other conditions, known as Brugada phenocopy.
- Anomalous aortic origin of the coronary artery (AAOCA) is a rare congenital heart defect.
Abstract:
Brugada syndrome (BrS) is a sudden cardiac death syndrome characterized by a coved-type electrocardiogram (ECG). Different disorders, such as ischemia, can emulate a Brugada-pattern ECG (Brugada phenocopy). We report herein, the first case of surgical epicardial electrophysiological mapping in a successfully resuscitated patient with an anomalous aortic origin of the coronary artery (AAOCA) associated with a coved-type ECG. It was debatable whether the coved-type ECG and the abnormal arrhythmogenic substrate in the epicardial right ventricular outflow tract were derived from BrS or from repetitive ischemia due to AAOCA; however, the epicardial electrophysiological mapping helped in deciding the treatment strategy.
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