scholarly journals Incidental Findings of Brugada Syndrome Type-1 and Epsilon-Like Pattern in Otherwise Healthy Man: a Case Report

2022 ◽  
Author(s):  
Brian Mendel ◽  
Valerie Dirjayanto ◽  
Radityo Prakoso ◽  
Sisca Siagian
Keyword(s):  
Brugada Syndrome ◽  
Unknown Origin ◽  
Initial Assessment ◽  
Structural Abnormality ◽  
Bundle Branch Block ◽  
Case Presentation ◽  
Electrophysiology Study ◽  
Esc Guidelines

Abstract Background: Brugada Syndrome (BrS) and arrhythmogenic right ventricle dysplasia (ARVD) are rare cardiomyopathies predisposing to sudden cardiac death (SCD). Comprehending the electrocardiographic features of these cardiomyopathies are crucial especially in emergency settings.Case presentation: A 25-year old medical student presented with no complaints, but had episodes of syncope, chest pain, and palpitations of unknown origin 10 years ago. The initial assessment showed stable hemodynamics. During examination, the ECG demonstrated incomplete right bundle branch block, Brugada-type 1 pattern, with signs of Epsilon wave. The following year, assessment of the ECG was repeated and findings were found suggestive of Brugada syndrome, although his echocardiography showed no structural abnormality. According to ESC guidelines, asymptomatic Brugada patients should undergo electrophysiology study.Conclusion: Careful follow-up with electrophysiology study is recommended for this patient in order to identify the likelihood of true Brugada and suitability for radiofrequency ablation or implantation of implantable cardioverter defibrillator (ICD).

scholarly journals Sudden Cause of Cardiac Death—Be Aware of Me: A Case Report and Short Review on Brugada Syndrome

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
Jagadeesh K. Kalavakunta ◽  
Vishwaroop Bantu ◽  
Hemasri Tokala ◽  
Mihas Kodenchery
Keyword(s):  
Brugada Syndrome ◽  
Past History ◽  
Short Review ◽  
Case Presentation ◽  
St Segment Elevation ◽  
First Case ◽  
St Segment ◽  
The Right ◽  
Malignant Arrhythmias

Introduction. Brugada syndrome accounts for about 4% of sudden cardiac deaths (SCD). It is characterized by an ST-segment elevation in the right precordial electrocardiogram (EKG) leads.Case Presentation. We describe a 39-year-old healthy Caucasian man who was admitted to the intensive care unit after being cardioverted from ventricular fibrillation (VF) arrest. His past history was significant for an episode of syncope one month prior to this presentation for which he was admitted to an outlying hospital. EKG during that admission showed ST elevations in V1 and V2 leads, a pattern similar to Type 1 Brugada. A diagnosis of Brugada syndrome was missed and the patient had a cardiac arrest a month later. We discuss a short review of Brugada syndrome and emphasize the need to look for it in patients presenting with SCD and malignant arrhythmias.Conclusion. Physicians should always consider Brugada syndrome in the differential diagnosis of ST-segment elevation in anterior precordial leads of EKG and associated VT/VF. Although more than 17 years have passed since the first case was reported, increased awareness of this syndrome is needed to identify patients with EKG changes and treat them accordingly to prevent incidence of (SCD) and its deleterious complications.

Surgical Treatment of a Symptomatic Diaphyseal Tibiofibular Synostosis in a Professional Rugby Player: A Case Report and Literature Review

2021 ◽  
pp. 1-7
Author(s):  
Guillaume Mirouse ◽  
Houssam Bouloussa ◽  
Hervé Silbert ◽  
Emad Lotfalizadeh ◽  
Arnaud Dubory
Keyword(s):  
Conservative Treatment ◽  
Recovery Time ◽  
Sport Activity ◽  
Unknown Origin ◽  
Rugby Player ◽  
Interosseous Membrane ◽  
Case Presentation ◽  
Senior Patients ◽  
Return To Competition

Context: Diaphyseal tibiofibular synostosis (DTS) is a rare pathology with unknown origin especially occurring in intensive sport athletes. No therapeutic guideline has been well established in the literature. Case Presentation: A rare case of DTS in a 26-year-old professional rugby player has been described. A 5-month exhaustive conservative treatment including physiotherapy and oral medication has been achieved but failed. Management and Outcomes: Following the conservative treatment failure, the DTS has been widely removed including the adjacent interosseous membrane, and the patient could return to competition at the same level after 5 months of convalescence. No recurrence has been revealed at a 35-month follow-up at least. Conclusion: In accordance with the literature data and even if the pathophysiology remains obscure, resection of DTS seems to be the adapted treatment to allow and to reduce professional athletes’ recovery time at the same sport level. The resection including a part of the tibiofibular interosseous membrane could avoid the occurrence of recurrence. Conservative treatment should be reserved for senior patients with a low sport activity.

scholarly journals Early and Late Endograft Limb Proximal Migration with Resulting Type 1b Endoleak following an EVAR for Ruptured AAA

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Patrick T. Jasinski ◽  
Demetri Adrahtas ◽  
Spyridon Monastiriotis ◽  
Apostolos K. Tassiopoulos
Keyword(s):  
Aortic Rupture ◽  
Endovascular Techniques ◽  
Case Presentation ◽  
Iliac Arteries ◽  
Proximal Migration ◽  
Abdominal Aortic ◽  
Potential Risk Factors ◽  
The Right

Introduction. Seal zone failure after EVAR leads to type 1 endoleaks and increases the risk of delayed aortic rupture. Type 1b endoleaks, although rare, represent a true risk to the repair. Case Presentation. We report the case of a 65-year-old female who underwent emergent endovascular repair for a ruptured infrarenal abdominal aortic aneurysm and developed bilateral type 1b endoleaks following proximal migration of both endograft limbs. The right-side failure was diagnosed within 48 hours from the initial repair and the left side at the 1-year follow-up. Both sides were successfully treated with endovascular techniques. A review of the literature with an analysis of potential risk factors is also reported. Conclusion. For patients undergoing EVAR for ruptured AAA and with noncalcified iliac arteries, more aggressive oversizing of the iliac limbs is recommended to prevents distal seal zone failures.

scholarly journals Ventricular Tachyarrhythmia Risk in Paediatric/Young vs. Adult Brugada Syndrome Patients: A Territory-Wide Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Sharen Lee ◽  
Wing Tak Wong ◽  
Ian Chi Kei Wong ◽  
Chloe Mak ◽  
Ngai Shing Mok ◽  
...  
Keyword(s):  
Brugada Syndrome ◽  
Adult Population ◽  
Ventricular Tachyarrhythmia ◽  
Management Strategies ◽  
Public Hospitals ◽  
Initial Presentation ◽  
P Wave ◽  
The Mean

Introduction: Brugada syndrome (BrS) is a cardiac ion channelopathy with a higher prevalence in Asia compared to the Western populations. The present study compared the differences in clinical and electrocardiographic (ECG) presentation between paediatric/young (≤25 years old) and adult (>25 years) BrS patients.Method: This was a territory-wide retrospective cohort study of consecutive BrS patients presenting to public hospitals in Hong Kong. The primary outcome was spontaneous ventricular tachycardia/ventricular fibrillation (VT/VF).Results: The cohort consists of 550 consecutive patients (median age of initial presentation = 51 ± 23 years; female = 7.3%; follow-up period = 83 ± 80 months), divided into adult (n = 505, mean age of initial presentation = 52 ± 19 years; female = 6.7%; mean follow-up period = 83 ± 80 months) and paediatric/young subgroups (n = 45, mean age of initial presentation = 21 ± 5 years, female = 13.3%, mean follow-up period = 73 ± 83 months). The mean annual VT/VF incidence rate were 17 and 25 cases per 1,000 patient-year, respectively. Multivariate analysis showed that initial presentation of type 1 pattern (HR = 1.80, 95% CI = [1.02, 3.15], p = 0.041), initial asymptomatic presentation (HR = 0.26, 95% CI = [0.07, 0.94], p = 0.040) and increased P-wave axis (HR = 0.98, 95% CI = [0.96, 1.00], p = 0.036) were significant predictors of VT/VF for the adult subgroup. Only initial presentation of VT/VF was predictive (HR = 29.30, 95% CI = [1.75, 492.00], p = 0.019) in the paediatric/young subgroup.Conclusion: Clinical and ECG presentation of BrS vary between the paediatric/young and adult population in BrS. Risk stratification and management strategies for younger patients should take into consideration and adopt an individualised approach.

P95412 lead Holter monitoring in Brugada syndrome

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
P Carvalho ◽  
C Gravinese ◽  
A Previti ◽  
G P Varalda ◽  
L Montagna
Keyword(s):  
Brugada Syndrome ◽  
Electrophysiological Study ◽  
Right Ventricular Outflow Tract ◽  
Holter Monitoring ◽  
The Other ◽  
Drug Induced ◽  
Premature Ventricular Contractions ◽  
Bundle Branch Block ◽  
The Right

Abstract Background 12 lead-Holter monitoring is commonly used for the assessment  of type 1 Brugada repolarization"s burden. However, data considering the prevalence and morphology of premature ventricular contractions (PVC) in these patients is lacking. Purpose. We investigated the prevalence of PVCs in subjects with Brugada syndrome (BRs) phenotype during 24-hour 12 lead-Holter monitoring (12-L Holter), trying to identify their origin according to morphology.  Methods. From January 2013 to September 2018, a total of 156 patients with type 1 BRs phenotype (spontaneous or drug induced) were screened for PVCs. In these patients we placed the right precordial leads at the second (V1-V2) and the forth (V3-V4) intercostal spaces.  Results. 83 subjects (53%) displayed PVCs. Their mean age was 50 years (range 21-73) and 63 (76%) were male. 14 subjects (17%) had a spontaneous type 1 repolarization whereas 69 (83%) presented a drug induced type 1. One patient had implanted an ICD as secondary prevention after an aborted sudden cardiac death. The others were mostly asymptomatic as only five of them (6%) had history of suspected cardiac syncope. 17 subjects (20%) had performed an electrophysiological study, which resulted positive in 3 cases (4%). The population without PVCs had similar baseline characteristics. In 59 (71%) patients PVCs were monomorphic, in the other 29% we analyzed the prevalent morphology. PVCs were classified according to their morphology as follows (i) left bundle branch block (LBBB)/inferior axis suggesting an origin from the right ventricular outflow tract (RVOT), that was shown in 40 (48%) subjects; (ii) right bundle branch block (RBBB)/left axis suggesting an origin close to the posterior fascicle of the left bundle branch in 36 (43%). The other 7 patients presented several morphologies. According to their number during the 24-hour monitoring, PVCs were arbitrarily classified as follows: (i) 1-59,present in 62 patients (75%); (ii) 60-749, present in 16 patients (19%); (iii) 750-9000, present in 4 patients (5%); (iv) >9000, in only one patient (1%).  Conclusions. In our population of subjects with BRs phenotype the prevalence of PCVs is similar to that of the general population. Their morphologies suggest an origin from the RVOT or close to the posterior fascicle of the left bundle branch.

scholarly journals Risk stratification of patients with Brugada syndrome (BrS): the impact of myocardial strain analysis using cardiac magnetic resonance myocardial feature tracking (CMR-FT)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.L Hohneck ◽  
D Overhoff ◽  
M Rutsch ◽  
B Rudic ◽  
E Tueluemen ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Brugada Syndrome ◽  
Myocardial Strain ◽  
Strain Analysis ◽  
Funding Source ◽  
Myocardial Strain Analysis ◽  
The Impact

Abstract Objectives This study evaluated the prognostic significance of cardiac magnetic resonance myocardial feature racking (CMR-FT) in patients with Brugada syndrome (BrS) to detect subclinical alterations and predict major adverse events (MAE). Methods and results CMR was performed in 106 patients (pts) with BrS. Biventricular global strain analysis was assessed using CMR-FT. Pts were followed for a mean of 11.1±3.5 years. The study cohort was subdivided according to the presence of a spontaneous type 1 ECG (sECG), into sBrS (BrS with sECG, n=34 (32.1%)) and diBrS (BrS with drug-induced type 1 ECG, n=72 (67.9%)). Both left and right ventricular (RV) ejection fraction were reduced within the normal range in sBrS pts. CMR-FT revealed morphological differences between sBrS and diBrS pts regarding RV strain (circumferential (%) (sBrS 7.9±2.9 vs diBrS −9.5±3.1, p=0.02) and radial strain (%) (sBrS 12.0±4.3 vs diBrS 15.4±5.4, p<0.01)). During follow up, MAE were noted in 12 pts (11.3%). The presence of a sECG was the strongest predictor for MAE (OR 0.70, 95% CI 0.53–0.90; p=0.008). RV global circumferential strain (GCS) was also associated with MAE (OR 0.16, 95% CI 0.03–0.82; p=0.03). A risk model which combined these two identified predictors showed a substantial risk increase for patients with both sECG and reduced RV-GCS. Conclusion Myocardial strain analysis detected early subclinical alterations, prior to apparent changes in myocardial function, in patients with BrS. Moreover, RV-GCS provided additional prognostic information on the occurrence of MAE during follow-up. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Deutsches Zentrum für Herz- und Kreislaufforschung (DZHK), German Centre for Cardiovascular Research

scholarly journals Eumycetoma Osteomyelitis Calcaneus in Adolescent; report of case and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ammar Awad ◽  
Adnan Alnaser ◽  
Hozifa Abd-elmaged ◽  
Reyad Abdallah ◽  
Hussam S. Khougali
Keyword(s):  
Initial Assessment ◽  
Ankle Pain ◽  
Incision And Drainage ◽  
Case Presentation ◽  
X Ray ◽  
Important Differential Diagnosis ◽  
Adolescent Report ◽  
Culture And Sensitivity ◽  
Aggressive Debridement

Abstract Background Mycetoma is the most common neglected disease in humans. It is a chronic, progressive, and destructive disease primarily caused by fungi or bacteria characterized by formation of dark pale grains commonly involve skin, soft tissue and rarely bone. Case presentation A 19 year old male patient with chronic right ankle pain, swelling and abscess formation for more than 1 year, patient was treated repeatedly with incision and drainage without any success. No X-ray, biopsy or swab for culture and sensitivity had been considered through the course of presentation. Patient was referred to Omdurman hospital where osteomyelitis secondary euomycetoma infection has been confirmed based on radiological and pathological assessment. Patient was treated surgically with aggressive debridement and bone curettage plus postoperative Itraconazole for 1 year. Conclusion Clinicians must consider osteomyelitis as important differential diagnosis during initial assessment Eumycetoma infection in adults. Aggressive bone curettage followed by regular X-ray follow up can be limb saving procedure in such cases.

Association of atrial septal defect and Brugada syndrome in a young woman

2021 ◽  
pp. 1-3
Author(s):  
Tomoya Tsuchihashi ◽  
Masahiro Kamada ◽  
Yukiko Nakano
Keyword(s):  
Atrial Septal Defect ◽  
Young Woman ◽  
Atrioventricular Block ◽  
Brugada Syndrome ◽  
Septal Defect ◽  
Bundle Branch Block ◽  
Slight Fever ◽  
Asd Closure ◽  
Brugada Pattern

Abstract We report a 25-year-old woman who was diagnosed with atrial septal defect (ASD). An ECG showed only first-degree atrioventricular block and incomplete right bundle branch block. One day after the percutaneous ASD closure, she had a slight fever and an ECG showed a type 1 Brugada pattern. ECG characteristics of ASD are similar to those of a Brugada ECG. This case is rare combination of Brugada syndrome with ASD.

851Predictors and causes of inappropriate shocks by subcutaneous defibrillators (S-ICD) in a cohort of sardinian Brugada syndrome patients

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
P M Berne ◽  
T Fancello ◽  
G Viola ◽  
V Carboni ◽  
G Mula ◽  
...  
Keyword(s):  
High Risk ◽  
Brugada Syndrome ◽  
S Wave ◽  
Inappropriate Shock ◽  
Pass Filter ◽  
Inappropriate Shocks ◽  
History Of ◽  
High Pass

Abstract Funding Acknowledgements Project Code CRP- 6175. Regione Autonoma della Sardegna Background The subcutaneous defibrillator (S-ICD) is an attractive option for patients with Brugada syndrome (BrS) at high risk, as it is highly effective to prevent arrhythmic sudden cardiac death (SCD) while avoiding some of the complications associated to transvenous devices. However, S-ICD are not free from complications, one of the most common being inappropriate shocks. Objective To assess the causes and predictors of inappropriate shocks by subcutaneous defibrillators (S-ICD) in a cohort of sardinian BrS patients Methods From February 2013 to September 2019, 373 patients were diagnosed as BrS patients. Sixty-five patients were considered to be at high risk of SCD, and implanted with an ICD. Of them, 36 were implanted with an S-ICD. Patients went through regular follow-up visits (physical examination, 12-lead ECG, device interrogation, occurrence of symptoms). Appropriate and inappropriate shocks were analyzed to establish their cause. Results Thirty-six BrS patients were implanted with an S-ICD (9.7% of the total BrS group, 55% of ICD implants). Twenty-four patients (67%) were male, mean age at diagnosis was 45± 14 y.o., and 31 (86%) were probands.  Seventeen patients (47%) had a family history of SCD. Ten patients (28%) had a spontaneous type 1 ECG at diagnosis and 14 (19%) had an spontaneous type 1 ECG at least once since the diagnosis , 2 patients (5.7%) had a type 1 ECG during fever, and 11 (31%) presented an S wave ≥40 msec in lead DI. Twelve patients (33%) underwent EP study, and 8 (67%) were inducible for ventricular fibrillation. During a mean follow-up of 46 ± 67 months, 2 patients (6%) had appropriate shocks, while 5 (14%) had inappropriate shocks. The rate between inappropriate and appropriate shock was 2.5.  The causes of inappropriate shock were T-wave oversensing (4 patients, 80%) and air entrapment (1 patient, 20%). Gender, proband status, sport practice, family history of SCD, type 1 ECG during fever, S wave ≥40 msec in lead DI, VF inducibility EP study, or the presence of symptoms during the follow-up (vaso-vagal syncope, arrhythmic syncope, nocturnal enuresis, ventricular fibrillation, atrial fibrillation) did not associated with inappropriate shock; neither did the technique of screening for S-ICD (manual or automated tool) nor the selected vector of sensing of the S-ICD. A spontaneous type 1 ECG at diagnosis (4 (80%) versus 6 (21%), p = 0.009), or at any time from diagnosis during follow-up (4 (80%) versus 10 (33%), p = 0.0049) and having a high-pass filter programmed OFF/not available [3 (75% versus 7 (25%), p = 0.044], were significantly associated with inappropriate shock of S-ICD in these population. Conclusions Brugada syndrome patients implanted with S-ICD present a higher rate of inappropriate shock compared to appropriate shock (2.5 times). Patients with spontaneous type 1 ECG are at  higher risk to receive inappropriate shock from S-ICDs, while programming a high-pass filter ON may prevent some of these episodes.

scholarly journals Permanent pacemaker implantation in unexplained syncope patients with electrophysiology study-proven atrioventricular node disease

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
I Doundoulakis ◽  
KA Gatzoulis ◽  
P Arsenos ◽  
P Dilaveris ◽  
D Tsiachris ◽  
...  
Keyword(s):  
Pacemaker Implantation ◽  
Atrioventricular Node ◽  
Initial Assessment ◽  
Funding Sources ◽  
Permanent Pacing ◽  
Electrophysiology Study ◽  
Node Disease ◽  
History Of ◽  
Unexplained Syncope

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction: Syncope, whose cause is unknown after an initial assessment, has an uncertain prognosis. It is critical to identify patients at highest risk who may require a pacemaker and to identify the cause of recurrent syncope to prescribe proper therapy Purpose Aim of this study was to evaluate the effect of permanent pacing on the incidence of syncope in patients with unexplained syncope and electrophysiology study-proven atrioventricular node disease. Methods This was an observational study based on a prospective registry of 236 consecutive patients (60.20 ± 18.66 years, 63.1% male, 60.04 ± 9.50 bpm) presenting with recurrent unexplained syncope attacks admitted to our hospital for invasive electrophysiology study (EPS). Τhe implantation of a permanent antibradycardia pacemaker (ABP) was offered to all patients according to the results of the EPS. 135 patients received the ABP, while 101 denied. Results The mean of reported syncope episodes was 1.97 ± 1.10 (or presyncope 2.17 ± 1.50) before they were referred for a combined EP guided diagnostic and therapeutic approach. Over a mean follow-up of approximately 4 years (49.19 ±  29.58 months), the primary outcome event (syncope) occurred in 31 of 236 patients (13.1%), 6 of 135 (4.4%) in the ABP group as compared to 25 of 101 (24.8%) in the no pacemaker group (p < 0.001). Conclusion Among patients with a history of unexplained syncope, a set of positivity criteria for the presence of EPS defined atrioventricular node disease, identifies a subset of patients who will benefit from permanent pacing.

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