Unmasking Brugada Syndrome With Oral Propafenone in a Resource-Limited Setting: A Case Report

Brugada syndrome (BrS) is a cardiac channelopathy predisposing patients to malignant ventricular arrhythmias and sudden cardiac death (SCD) in the absence of structural heart disease. The diagnosis requires documentation of a type 1 Brugada electrocardiographic pattern, which can be unmasked using sodium channel-blocking agents in symptomatic patients presenting with non-diagnostic baseline patterns. We report a case of a 24-year-old male patient with a history of unexplained syncope who exhibited a non-diagnostic type 2 Brugada pattern on a baseline electrocardiogram (ECG). Due to the local unavailability of standard intravenous antiarrhythmics, a pharmacological provocation test was conducted using a single 600 mg oral dose of propafenone. Under continuous cardiac monitoring, the patient safely developed a diagnostic type 1 "coved" electrocardiographic pattern starting at the third hour, confirming the diagnosis of BrS. The ECG returned to its baseline pattern eight hours after the initiation of the test, and no cardiovascular complications occurred. This case highlights the clinical utility and safety of oral propafenone as an effective alternative diagnostic challenge for unmasking BrS in resource-limited environments. Furthermore, it emphasizes the necessity of utilizing extended monitoring protocols due to the specific pharmacokinetic profile and delayed onset of action of oral agents.