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Deceptive Anteroseptal ST-segment Elevation and Brugada Pattern Caused by Isolated Conus Artery Occlusion

Hakan Gökalp Uzun1, İrfan Özgen1

  • 1Izmir Tepecik Training and Research Hospital - Department of Cardiology, Konak, İzmir - Turquia.

Arquivos Brasileiros De Cardiologia
|July 17, 2024
PubMed

Insights

Catheter dissection of the conus artery (CA) caused ST-segment elevation mimicking Brugada patterns. This rare case highlights that not all CA occlusions lead to Brugada-like electrocardiogram changes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Electrocardiography

Background:

  • The conus artery (CA) is crucial for supplying the right ventricular outflow tract (RVOT).
  • Occlusion of the CA can present with ST-segment elevation in leads V1-3, mimicking Brugada electrocardiogram (EKG) patterns.
  • Catheter-induced dissections are a known complication in interventional cardiology.

Observation:

  • A 68-year-old male presented with non-ST-elevation myocardial infarction.
  • Coronary angiography revealed a catheter-induced dissection in the CA.
  • Post-procedure EKG showed ST-segment elevations in V1-4, consistent with Brugada patterns (type-1 and type-2).
  • Subsequent imaging confirmed total occlusion of the CA, with unsuccessful attempts at revascularization.

Findings:

  • This is the first reported case of catheter dissection leading to CA occlusion.
  • The presentation included anteroseptal ST-segment elevation without anginal symptoms or arrhythmias.
  • The observed EKG changes resembled Brugada patterns but differed in severity compared to true Brugada syndrome.
  • Conus artery obstruction does not invariably cause Brugada-like EKG patterns.

Implications:

  • Catheter-induced CA dissection is a potential cause of Brugada-like EKG changes.
  • Clinical presentation of CA occlusion can vary, sometimes lacking typical symptoms.
  • Further research is needed to understand the spectrum of EKG manifestations in CA-related events.
  • This case expands the differential diagnosis for ST-segment elevation myocardial infarction and Brugada patterns.

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