Korean Circ J.  2013 Jun;43(6):426-428. 10.4070/kcj.2013.43.6.426.

An Iatrogenically Unmasked Life Threatening Disease: Brugada Syndrome

• Ercan S
• Oylumlu M
• Altunbas G
• Davutoglu

• KMID: 2224906
• DOI: http://doi.org/10.4070/kcj.2013.43.6.426

Abstract

Brugada syndrome is a life threatening disease that is usually overlooked during emergency service admissions. It is characterized by typical electrocardiography resembling right bundle branch block, static or dynamic ST-segment elevation in leads V 1-3. There is familial tendency in some cases. A majority of patients have a structurally normal heart and are likely to remain asymptomatic, however they may present to emergency departments with syncope and various serious arrhythmias. Therefore it is crucially important for emergency medicine physicians not to omit this potential diagnosis. Herein we report a case with Brugada syndrome which was iatrogenically unmasked after propafenone administration for atrial fibrillation.

Keyword

Brugada syndrome; Propafenone; Atrial fibrillation; Acute myocardial infarction

MeSH Terms

Arrhythmias, Cardiac
Atrial Fibrillation
Brugada Syndrome
Bundle-Branch Block
Electrocardiography
Emergencies
Emergency Medicine
Heart
Humans
Propafenone
Syncope
Propafenone

Figure

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  Fig. 1 Electrocardiography on presentation, revealing atrial fibrillation.

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  Fig. 2 Electrocardiogram one hour after administration of propafenone. Reading was confused with acute myocardial infarction.

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  Fig. 3 Electrocardiography after direct current cardioversion.

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  Fig. 4 Electrocardiography of patient's sister, revealing pattern of Brugada type 2.

Reference

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2. Brugada J, Brugada R, Brugada P. Right bundle-branch block and ST-segment elevation in leads V1 through V3: a marker for sudden death in patients without demonstrable structural heart disease. Circulation. 1998; 97:457–460.

3. Antzelevitch C. The Brugada syndrome. J Cardiovasc Electrophysiol. 1998; 9:513–516.

4. Chutani S, Imran N, Grubb B, Kanjwal Y. Propafenone-induced Brugada-like ECG changes mistaken as acute myocardial infarction. Emerg Med J. 2008; 25:117–118.