Syncope and "Normal" ECG: Is Brugada Syndrome the Culprit?

Area of Science:

• Cardiology
• Genetics
• Electrophysiology

Background:

• Brugada syndrome (BrS) is an inherited cardiac arrhythmia associated with sudden cardiac death (SCD) in structurally normal hearts, often linked to SCN5A gene variants.
• The diagnostic hallmark of BrS is the Type 1 electrocardiogram (ECG) pattern, characterized by specific J-point elevation and T-wave morphology in anterior leads.

Observation:

• The case involves a young male presenting with syncope and an initial non-diagnostic ECG.
• Subsequent ECG monitoring revealed the development of a Type 1 Brugada pattern.
• The patient also experienced an episode of non-sustained ventricular tachycardia.

Findings:

• The study underscores the dynamic nature of ECG manifestations in Brugada syndrome.
• It emphasizes the critical importance of differentiating true BrS from Brugada phenocopies, which mimic the Type 1 ECG pattern due to various conditions.
• The case illustrates the potential for syncope and ventricular arrhythmias in patients with evolving BrS.

Implications:

• Accurate identification of the Type 1 Brugada ECG pattern is crucial for timely diagnosis and management.
• Ruling out Brugada phenocopies is essential to avoid misdiagnosis and ensure appropriate patient care.
• This case highlights the need for vigilant ECG monitoring in patients with unexplained syncope, particularly when initial findings are equivocal.