scholarly journals Ventricular fibrillation arrest due to Brugada syndrome in a COVID-19 patient with negative procainamide challenge: a case report

2021 ◽  
Author(s):  
Guangchen Zou ◽  
Mukul Khanna ◽  
Saliha Zahid ◽  
Samir Dengle ◽  
Bhavna Matta ◽  
...  
Keyword(s):  
Ventricular Fibrillation ◽  
Brugada Syndrome ◽  
Stress Test ◽  
Challenge Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Type I ◽  
Icd Implantation ◽  
Brugada Pattern

Abstract Background Pharmacologic challenge test is often used to diagnose Brugada syndrome (BrS) when spontaneous ECGs do not show type I Brugada pattern but reported sensitivity varies. The role of exercise stress test in diagnosing Brugada syndrome is not well-established. Case Summary A patient had a type I Brugada pattern ECG during the recovery phase of exercise stress test but had a negative procainamide challenge test. He had a loop recorder implanted and later survived a ventricular fibrillation (VF) arrest provoked by COVID-19. ECG on arrival showed type 1 Brugada pattern. He was discharged after implantable cardioverter-defibrillator (ICD) implantation. He later underwent genetic testing and was found to be heterozygous for c.844C>G (p.Arg282Gly) mutation in the SCN5A gene. Discussion Type 1 Brugada pattern ECG may be unmasked by ST segment augmentation during recovery from exercise. Exercise stress test may play a role in diagnosis of Brugada syndrome when suspicion for Brugada syndrome remains after a negative procainamide challenge test or if the patient has exercise related symptoms. COVID-19 can unmask BrS and trigger a VF cardiac arrest.

scholarly journals Type 1 Brugada Pattern Unmasked During the Recovery Period of an Exercise Stress Test

2016 ◽  
Author(s):  
Daniel García-Fuertes ◽  
Elena Villanueva-Fernández ◽  
Manuel Crespín-Crespín ◽  
Alberto Puchol ◽  
Marta Pachón ◽  
...  
Keyword(s):  
Stress Test ◽  
Recovery Period ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Brugada Pattern

scholarly journals Exercise stress test reveals ineligibility for subcutaneous implantable cardioverter defibrillator in patients with Brugada syndrome

2017 ◽  
Vol 28 (12) ◽  
pp. 1454-1459 ◽  
Author(s):  
Motomi Tachibana ◽  
Nobuhiro Nishii ◽  
Hiroshi Morita ◽  
Koji Nakagawa ◽  
Atsuyuki Watanabe ◽  
...  
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
Brugada Syndrome ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Cardioverter Defibrillator

Monogenic and oligogenic cardiovascular diseases: genetics of arrhythmias—catecholaminergic polymorphic ventricular tachycardia

ESC CardioMed ◽  
2018 ◽  
pp. 683-685
Author(s):  
Peter J. Schwartz ◽  
Lia Crotti
Keyword(s):  
Ventricular Tachycardia ◽  
Beta Blockers ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Catecholaminergic Polymorphic Ventricular Tachycardia ◽  
Exercise Stress ◽  
Polymorphic Ventricular Tachycardia ◽  
Cascade Screening ◽  
Icd Implantation ◽  
Symptomatic Diagnosis

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited disorder associated with syncope and sudden death manifesting in the young during sympathetic activation. The electrocardiogram is normal and the heart is structurally normal. The diagnosis is usually made with an exercise stress test that shows a typical pattern of onset and offset of adrenergically induced ventricular arrhythmias. Molecular screening of RyR2, the major CPVT gene, is recommended whenever the suspicion of CPVT is high. If a disease-causing mutation is identified, cascade screening allows pre-symptomatic diagnosis among family members. All affected subjects should be treated with beta blockers (nadolol or propranolol). Preliminary data support the association of beta blockers with flecainide. After a cardiac arrest, an implantable cardioverter defibrillator (ICD) should be implanted, but it is accompanied by a disquietingly high incidence of adverse effects. After syncope on beta blocker therapy, left cardiac sympathetic denervation is most effective, preserves quality of life, and does not preclude a subsequent ICD implantation.

Monogenic and oligogenic cardiovascular diseases: genetics of arrhythmias—catecholaminergic polymorphic ventricular tachycardia

2018 ◽  
Author(s):  
Peter J. Schwartz ◽  
Lia Crotti
Keyword(s):  
Ventricular Tachycardia ◽  
Beta Blockers ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Catecholaminergic Polymorphic Ventricular Tachycardia ◽  
Exercise Stress ◽  
Polymorphic Ventricular Tachycardia ◽  
Cascade Screening ◽  
Icd Implantation ◽  
Symptomatic Diagnosis

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited disorder associated with syncope and sudden death manifesting in the young during sympathetic activation. The electrocardiogram is normal and the heart is structurally normal. The diagnosis is usually made with an exercise stress test that shows a typical pattern of onset and offset of adrenergically induced ventricular arrhythmias. Molecular screening of RyR2, the major CPVT gene, is recommended whenever the suspicion of CPVT is high. If a disease-causing mutation is identified, cascade screening allows pre-symptomatic diagnosis among family members. All affected subjects should be treated with beta blockers (nadolol or propranolol). Preliminary data support the association of beta blockers with flecainide. After a cardiac arrest, an implantable cardioverter defibrillator (ICD) should be implanted, but it is accompanied by a disquietingly high incidence of adverse effects. After syncope on beta blocker therapy, left cardiac sympathetic denervation is most effective, preserves quality of life, and does not preclude a subsequent ICD implantation.

scholarly journals Brugada Syndrome Caused by Autonomic Dysfunction in Multiple Sclerosis

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Michel Ibrahim ◽  
Garly Saint-Croix ◽  
Rosario Colombo
Keyword(s):  
Multiple Sclerosis ◽  
Autonomic Dysfunction ◽  
Brugada Syndrome ◽  
Neurological Deficits ◽  
Type I ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Balance Problems ◽  
Brugada Pattern

Only one case report has previously described a patient with multiple sclerosis and a type 1 Brugada pattern on the electrocardiogram. Patients with multiple sclerosis have several neurological deficits including sensory symptoms, acute or subacute motor weakness, gait disturbance, and balance problems that may lead to an increased risk of falls. Concurrent autonomic dysfunction and neurologic consequences of multiple sclerosis may precipitate both mechanical falls and falls with loss of consciousness. While mechanistically different, the type 1 Brugada pattern presents similarly with syncope due to an insufficient cardiac output during dysrhythmia. In such patients, intracardiac defibrillators have shown to prevent sudden cardiac death in patients with the Brugada syndrome. In light of these similarly presenting but unique clinical entities, MS patients who develop a syncopal event in the setting of a spontaneous type I Brugada pattern pose a diagnostic and therapeutic dilemma. This case illustrates an approach to the risks and benefits of an ICD placement in an MS patient with the type 1 Brugada pattern.

scholarly journals Unmasking Brugada Syndrome with Oral Flecainide Provocation. A Case Series of Three Patients

2019 ◽  
pp. 1-6
Author(s):  
R. Singla ◽  
A. Udyavar ◽  
A. Gupta ◽  
A. Bade ◽  
K. Munde ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Brugada Syndrome ◽  
Cardiac Death ◽  
Challenge Test ◽  
Sudden Cardiac Arrest ◽  
Case Series ◽  
St Segment Elevation ◽  
Brugada Pattern

The present case series discuss three patients who had brugada type 2/ type 3 like ECG pattern that was converted to type 1 pattern with oral flecanide challenge test. Brugada syndrome is associated with a high incidence of sudden cardiac death,   typical ECG pattern being ST-segment elevation in the right precordial leads with T wave inversion. Pharmacological provocation should only be performed when the baseline ECG is not diagnostic of Brugada Syndrome. PR prolongation in the baseline ECG is also a contraindication because of the risk of inducing AV block. Drug challenge is performed under strict monitoring of BP and 12-lead ECG and facilities for cardio version and resuscitation are available. Atypical RBBB pattern/type 2/3 Brugada pattern on ECG in patients of syncope or family history of sudden cardiac arrest is commonly encountered by a cardiologist. This can be performed to provoke type 1 brugada pattern on ECG. Diagnosed cases of Brugada may be treated with ICD with proper indication if needed and thus prevent sudden cardiac death.

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