Abstract 211: Dynamic Nature of Brugada Syndrome in Patients With Syncope. Possible Diagnostic Approaches in ER
Background: Brugada syndrome is known to manifest characteristic ST-segment elevation in the right precordial ECG leads with high incidence of sudden death due to lethal ventricular arrhythmias. Although patients with Brugada syndrome could be brought to ER with syncope, the incidence of Brugada syndrome with syncope in ER remains uncertain. The definite diagnosis of Brugada syndrome in ER is difficult because its ECG patterns are dynamic and often concealed based on a variety of conditions, and the precise diagnostic algorithm in ER has yet been established.
Methods: Consecutive 1,448 patients with syncope (762 male patients with median age of 56 years) brought to ER by ambulance between April 2007 and March 2010 were retrospectively analyzed.
Results: Of these syncopal patients, 6 patients (all male patients with 21–56 (median 45.5) years old) were diagnosed as Brugada syndrome in ER. Of these 6 patients, no one had family history of sudden cardiac death. Three patients had one or more previous syncopal episodes. Four patients were in febril state on arrival (37.0–39.9 °C). On arrival, only 1 patient manifested typical coved-type ST elevation in V1-V3 ECG leads, 4 patients revealed saddleback-like ST elevation in V2 lead, and the remaining 1 patient showed unique and marked ST elevation in V2 lead. The ECGs in the third intercostal space were obtained in all patients and showed evident and typical coved-type ST elevation in 5 patients, leading to a diagnosis of Brugada syndrome. Serial ECG recordings were needed in 1 patient because of its dynamic ECG changes corresponding to body temperature. In this case, the third intercostal ECG after 90 min finally revealed typical coved-type ST elevation in V1-V2 leads, resulting in a diagnosis of Brugada syndrome. Three patients were implanted ICD after EPS showing inducible ventricular fibrillation, and the remaining 3 patients are on careful observation because the informed consent to EPS and ICD implantation was not obtained.
Conclusions: Of the patients with syncope brought to ER, 0.4% was diagnosed as Brugada syndrome for the first time in ER. The third intercostal ECG and serial ECG recordings are greatly helpful in rapid diagnosis of Brugada syndrome in ER and may lead to advanced evaluation and optimal therapy.
- © 2010 by American Heart Association, Inc.