CONGRESS ABSTRACT

A 59 years-old male without relevant past medical history presented to our hospital because of an episode of chest pain followed by a syncope during driving, completely resolved once arrived at the ED. He complained of other chest pain episodes in the last past weeks. During hospitalization he has been asympthomatic and physical examination was unremarkable. ECG showed q waves in inferior leads and a Brugada pattern type 2. Cardiac enzymes were normal. Echocardiography showed akinesis of medio-basal inferior wall with slight reduction of EF (50%). Coronary angiography demonstrated a total occlusion of RCA and a 50% stenosis of LCA, treated with PCI and DES implantation. A following ECG revealed a spontaneous Brugada pattern type 1. This element let us reevaluate his past syncope nature. Electrophysiologists were consulted and the patient was deemed to be at low risk for sudden cardiac death. No ICD was indicated and a loop recorder was implanted. He underwent genetic test for Brugada syndrome, still pending at the moment. Brugada syndrome is a congenital electrical disorder associated with a high risk of ventricular arrhythmias and sudden cardiac death. Cardiac sodium channel gene SCN5A mutations represent the most frequent genetic variant, also associated with other cardiac disorders, but other potentially pathogenic variants have been reported. Brugada syndrome is diagnosed in patients with a spontaneous type 1 ECG pattern, characterized by J point elevation of > 2 mV with coved ST elevation and T wave inversion in at least one right precordial ECG lead, V1 or V2, positioned in the second, third or fourth intercostal spaces. This is an unusual case of incidental evidence of Brugada pattern type 1 after coronary revascularization. According to latest guidelines, our patient, due to his unexplained syncope nature, was deemed to loop recorder implantation (IIA Class). Actually his syncope could be due to the total occlusion of RCA or an arrythmia correlated to Brugada syndrome. Only loop recorder monitoring and genetic test results will help us in our patient’s management and to consider the possibility of ICD implantation.