CONGRESS ABSTRACT

Brugada syndrome (BrS) is a hereditary arrhythmic disorder characterized by distinctive electrocardiographic (ECG) pattern, correlated with ventricular arrhythmias and sudden cardiac death in young adults. While primarily linked to a loss-of-function mutation in the SCN5A gene, acquired forms of the syndrome have been associated with various factors, including drug use. We present a case of a 49-year-old male with a history of cocaine abuse, who sought medical attention for sudden cardiac arrest after having snorted an impressive amount of cocaine. The patient underwent cardiac massage for several minutes at home until the emergency team arrived. The electrocardiogram showed a rhythm of ventricular fibrillation at low voltages, rapidly evolving into asystole (Fig 1). The patient was treated with adrenaline and resuscitation maneuvers until spontaneous circulation was restored. His ECG few hours after resuscitation showed a classical type 1 Brugada phenotype with SR’ pattern with coved ST-segment elevation and T inversion in V1 and V2 (Fig 2); however, previous and subsequent ECG were normal without ST changes, signifying the Brugada pattern unmasked by cocaine use. The patient did not have fever or electrolyte imbalances. The family denies any known hereditary diseases. In the following days the ECG returned normal, without ischemic changes and with complete regression of the Brugada pattern (Fig 3). The echocardiogram showed normal size and contractility of the left ventricle, no changes in regional kinetics, ejection fraction 60%. Unfortunately, the post-anoxic brain damage was devastating and the patient died after a week in the intensive care unit. The BrS is associated with a gene mutation affecting cardiac sodium channel characteristics. Cocaine also has a potent sodium channel blocking effect, which can prolong QT and QRS intervals, inhibiting the generation of action potentials, like that of class IC antiarrhythmic agent flecainide. Brugada syndrome should not be confused with other conditions which may mimic Brugada-like patterns Few similar cases have been published in the literature, but always with transient Brugada-like patterns. This is the first case in which the patient suffers cardiac arrest, which will later prove fatal