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Gepubliceerd in: Netherlands Heart Journal 9/2019

Open Access 21-05-2019 | Rhythm Puzzle - Answer

Funny waves in repolarisation and tachycardia in a patient suspected for Brugada syndrome

Auteurs: L. Jordaens, L. Timmers, P. Goethals

Gepubliceerd in: Netherlands Heart Journal | Uitgave 9/2019

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Answer

The resting electrocardiogram (ECG) is diagnostic for Brugada syndrome [1]. His 2 brothers both had ECG patterns typical for Brugada syndrome, his mother had drug-induced Brugada syndrome. His father was from East Asian descent. The waves in V2 are indeed suggestive of an epsilon wave, which might be a sign for arrhythmogenic right ventricular dysplasia, and hence an overlap situation [2]. However, there were no clinical, nor other signs for this disease, and the cardiac magnetic resonance imaging (MRI) was entirely normal. Depolarising abnormalities are observed in 13% of patients with spontaneous or drug-induced Brugada syndrome, without any evidence of cardiomyopathy [2]. The tachycardia was a left-sided posterior fascicular tachycardia and was easily ablated on a site with a Purkinje potential (Fig. 1 and 2). A dual-chamber implantable cardioverter-defibrillator was implanted, given the bradycardia and conduction disease. With a follow-up of 3 years, no events have been recorded. Fascicular tachycardia has in principle no relation with Brugada syndrome, which mainly affects the right ventricular outflow tract [3]. That some molecular common link may exist cannot be excluded. Genetic analysis showed 2 missense variants in the SCN5A gene, and one TMEM43 variant, all with unclear relation to his disease, given his East Asian roots.

Conflict of interest

L. Jordaens, L. Timmers and P. Goethals declare that they have no competing interests.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
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Literatuur
1.
go back to reference Gourraud JB, Barc J, Thollet A, et al. Brugada syndrome: Diagnosis, risk stratification and management. Arch Cardiovasc Dis. 2017;110:188–95. CrossRefPubMed Gourraud JB, Barc J, Thollet A, et al. Brugada syndrome: Diagnosis, risk stratification and management. Arch Cardiovasc Dis. 2017;110:188–95. CrossRefPubMed
2.
go back to reference Letsas KP, Efremidis M, Weber R, et al. Epsilon-like waves and ventricular conduction abnormalities in subjects with type 1 ECG pattern of Brugada syndrome. Heart Rhythm. 2011;8:874–8. CrossRefPubMed Letsas KP, Efremidis M, Weber R, et al. Epsilon-like waves and ventricular conduction abnormalities in subjects with type 1 ECG pattern of Brugada syndrome. Heart Rhythm. 2011;8:874–8. CrossRefPubMed
3.
go back to reference Rodríguez-Mañero M, Sacher F, de Asmundis C, et al. Monomorphic ventricular tachycardia in patients with Brugada syndrome: A multicenter retrospective study. Heart Rhythm. 2016;13:669–82. CrossRefPubMed Rodríguez-Mañero M, Sacher F, de Asmundis C, et al. Monomorphic ventricular tachycardia in patients with Brugada syndrome: A multicenter retrospective study. Heart Rhythm. 2016;13:669–82. CrossRefPubMed
Metagegevens
Titel
Funny waves in repolarisation and tachycardia in a patient suspected for Brugada syndrome
Auteurs
L. Jordaens
L. Timmers
P. Goethals
Publicatiedatum
21-05-2019
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 9/2019
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-019-1292-8

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