Abstract Exercise is anecdotally reported to induce further ST- segment elevation in Brugada patients, and there are experimental indications that exercise may play an arrhythmogenic role in Brugada syndrome patients. We present a case report of a Brugada type 1 electrocardiogram, induced by an exercise test. A 32 year old man presented an incidental type 2 pattern Brugada ECG. His grandmother had died suddenly at the age of 50, at rest, no autopsy had been performed. The patient was asymptomatic, with a silent cardiological history. He underwent a treadmill exercise test in the context of sports medicine. At baseline he exhibited a type 2 Brugada ECG, but at maximum exercise he presented an ST-segment elevation, with a coved morphology, of 5 mm in lead V2, of 2 mm in DI and of 4 mm in aVL. During the recovery phase the ST segment returned progressively to the baseline morphology. No arrythmias were recorded . The patient was submitted to echocardiography, coronary angiography , cardiac magnetic resonance, which excluded cardiac morphological abnormalities. It was also performed a flecainide test that did not induce a Brugada type 1 ECG. Nevertheless he was sent to our institution for genetic sampling. We re-evaluated the patient, performing an ajmaline test which induced a type 1 Brugada ECG after the infusion of 30 mg of ajmaline. There were no serious side effects. The patient was given the list of drugs to avoid, according to Brugada drugs.org. It was proposed an EP study that the patient refused. The genetics showed a mutation of the SCN5A gene present in other Brugada patients and never found in the control population. After a follow up of 32 months there were no cardiac events Conclusions: We present a case of type 1 Brugada ECG exercise induced. This diagnosis is confirmed by the exclusion of a cardiac organic disease, an ajmaline positive test and the presence of a SCN5A mutation. This case raises several questions such as the risk of cardiac events during sports or recreational activities, the role of EP study, the ICD indications. There is the need of systematic studies on the effects of exercise on the ECG phenotype of Brugada syndrome and the correlation with genetic results.
A case report of type 1 brugada ECG exercise induced
GIACHINO, Daniela Francesca;MANDRILE, Giorgia;
2013-01-01
Abstract
Abstract Exercise is anecdotally reported to induce further ST- segment elevation in Brugada patients, and there are experimental indications that exercise may play an arrhythmogenic role in Brugada syndrome patients. We present a case report of a Brugada type 1 electrocardiogram, induced by an exercise test. A 32 year old man presented an incidental type 2 pattern Brugada ECG. His grandmother had died suddenly at the age of 50, at rest, no autopsy had been performed. The patient was asymptomatic, with a silent cardiological history. He underwent a treadmill exercise test in the context of sports medicine. At baseline he exhibited a type 2 Brugada ECG, but at maximum exercise he presented an ST-segment elevation, with a coved morphology, of 5 mm in lead V2, of 2 mm in DI and of 4 mm in aVL. During the recovery phase the ST segment returned progressively to the baseline morphology. No arrythmias were recorded . The patient was submitted to echocardiography, coronary angiography , cardiac magnetic resonance, which excluded cardiac morphological abnormalities. It was also performed a flecainide test that did not induce a Brugada type 1 ECG. Nevertheless he was sent to our institution for genetic sampling. We re-evaluated the patient, performing an ajmaline test which induced a type 1 Brugada ECG after the infusion of 30 mg of ajmaline. There were no serious side effects. The patient was given the list of drugs to avoid, according to Brugada drugs.org. It was proposed an EP study that the patient refused. The genetics showed a mutation of the SCN5A gene present in other Brugada patients and never found in the control population. After a follow up of 32 months there were no cardiac events Conclusions: We present a case of type 1 Brugada ECG exercise induced. This diagnosis is confirmed by the exclusion of a cardiac organic disease, an ajmaline positive test and the presence of a SCN5A mutation. This case raises several questions such as the risk of cardiac events during sports or recreational activities, the role of EP study, the ICD indications. There is the need of systematic studies on the effects of exercise on the ECG phenotype of Brugada syndrome and the correlation with genetic results.
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