Vagally mediated ventricular arrhythmia in Brugada syndrome

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Presentation transcript:

Vagally mediated ventricular arrhythmia in Brugada syndrome Nicholay Teodorovich, MD, FHRS, Yonatan Kogan, MD, Offir Paz, MD, Moshe Swissa, MD, FHRS HeartRhythm Case Reports Volume 2, Issue 6, Pages 530-535 (November 2016) DOI: 10.1016/j.hrcr.2016.08.016 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 Electrocardiogram recorded by emergency medical services team demonstrating slow atrial fibrillation with short–coupling interval ventricular premature beats (280 ms) and ST elevation in V2-V3 and weak “coved-type” ST elevation in V1 compatible with Brugada syndrome. HeartRhythm Case Reports 2016 2, 530-535DOI: (10.1016/j.hrcr.2016.08.016) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 Electrocardiogram in sinus rhythm demonstrates ST elevations in V1-V3 consistent with Brugada syndrome together with short-coupled (250 msec) ventricular premature beats. HeartRhythm Case Reports 2016 2, 530-535DOI: (10.1016/j.hrcr.2016.08.016) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 An implantable cardioverter-defibrillator interrogation demonstrates a ventricular premature beat (VPB) with a short coupling interval (260 ms), which induced a ventricular fibrillation, which converted into sinus rhythm with 20.4 J. Slowing of the heart rate (from 520 to 740 msec) precedes a short-coupled VPB. HeartRhythm Case Reports 2016 2, 530-535DOI: (10.1016/j.hrcr.2016.08.016) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 4 A 24-hour Holter monitor performed at 8:10 PM demonstrates that ST elevations are much more prominent at night (Brugada type I pattern). The changes in the magnitude of the ST elevations are not rate dependent (ST elevations are much less prominent in the daytime recordings during both slow and fast heart rates). HeartRhythm Case Reports 2016 2, 530-535DOI: (10.1016/j.hrcr.2016.08.016) Copyright © 2016 Heart Rhythm Society Terms and Conditions