Brugada Electrocardiographic Pattern in an Older Man With Syncope

Abstract

A 61-year-old man with no history of heart or lung disease was admitted for benign prostatic hyperplasia surgery. On presentation, his physical examination findings were normal. His hemogram results and serum electrolyte levels were within normal limits. A 12-lead electrocardiogram (ECG) was obtained (Figure , A) at the time of admission. After a day of postoperative bed rest, he experienced sudden dyspnea and syncope while going to the toilet. His blood pressure was 75/38 mm Hg, and his peripheral oxygen saturation was 87% while breathing room air. There was obvious jugular venous distention. A repeated ECG is shown in the Figure , B.Questions: What are the clinically significant findings on the ECG in the Figure , B? What is the most likely diagnosis? InterpretationThe baseline 12-lead ECG shows sinus rhythm without obvious ST-T deviation. The repeated ECG shows atrial fibrillation (160 beats/ min) with rapid ventricular response, right axis deviation, S1Q3T3 pattern, ST-segment depression in leads V 4 to V 6 , ST-segment elevation in leads III, V 1 , and V 2 , and additional T-wave inversions in leads V 1 and V 2 that mimic a type 1 Brugada ECG pattern (named Brugada phenocopy [BrP]). All these ECG changes suggest a degree of right ventricular (RV) strain. Clinical CourseThe history of postoperative bed rest, signs of RV strain on the ECG, and dyspnea associated with syncope raised high suspicion of Figure. Electrocardiogram (ECG) Findings Admission ECG A Postsurgical ECG B A, Admission ECG showing sinus rhythm without obvious ST-T deviation. B, Postsurgical ECG showing ST-segment elevation on right precordial leads V 1 and V 2 that mimics a type 1 Brugada ECG pattern.

Syncope with QT‐interval prolongation and T‐wave inversion in anterior and inferior leads: Foreboder of a life‐threatening condition?

“…Several typical ECG changes are associated with PE, including P pulmonale, right axis deviation, S1S2S3 pattern, low voltage, clockwise rotation, right bundle‐branch block, S1Q3T3 pattern, arrhythmia, nonspecific ST‐segment changes, QR pattern in lead V1, Brugada ECG pattern, and T‐wave inversions in the precordial leads. (Ullman et al, 2001; Zhai & He, 2021) In addition, global T‐wave inversion with QT‐interval prolongation associated with acute PE has been described in an isolated case report. (Lui, 1993) Similarly, Zhao et al reported QT‐interval prolongation and T‐wave inversion in a patient with PE.…”

“…Brugada ECG pattern, and T-wave inversions in the precordial leads. (Ullman et al, 2001;Zhai & He, 2021) In addition, global T-wave inversion with QT-interval prolongation associated with acute PE has been described in an isolated case report. (Lui, 1993) Similarly, Zhao et al reported QT-interval prolongation and T-wave inversion in a patient with PE.…”