Atypical Cause of Syncope in Patients with Brugada Syndrome

Examination of a 32 year old male with chest pain and suggestive Brugada ECG pattern was sent to our outpatient clinic for cardiac evaluation. The patient denied having suffered any previous syncope. He had a positive history of intravenous drug abuse and was HBV+. There were no sudden deaths, although there was important consanguinity in the family. A complete cardiac study was carried out, including a drug challenge test with a sodium channel blocker (flecainide) that confirmed the diagnosis (Figure 1). The echocardiogram, 24 hours ECG holter monitoring, and electrophysiological study (ventricular programmed stimulation with up to three extrastimuli and three basic cycle lengths from right ventricular apex and outflow tract), were normal. A blood sample was taken for genetic testing, clinical check-up were recommended and a family study was started.