EKG of the Week

A 23 y/o male presents after a syncopal episode. His EKG is attached.

1. What is the diagnosis?

2. What is the treatment?

A1. Brugada's syndrome

A2. ICD

Brugada's syndrome is associated with ventricular dysrhythmias and syncope or sudden cardiac death in the absence of structural heart disease. Brugada's syndrome results from an inherited disorder of sodium channels and is most commonly present in males during young adulthood. The Brugada syndrome ECG pattern is characterized by a downward coved or humped (saddleback) ST segment elevation in leads V1 to V3, sometimes simulating an RBBB appearance. The ST segment findings may be transient or elicited only with pharmacologic stimulation.

Any patient with unexplained syncope and a Brugada-pattern ECG requires admission for consideration of an implanted defibrillator. For patients in whom a Brugada-pattern ECG is noted incidentally, there is no consensus on treatment, but referral to a cardiologist is advisable.

(Yealy, Kosowksy. Dysrhythmias. In Rosen’s Emergency Medicine, 8th ed. Chapter 79, p. 1062-3)