Rev. DERC (Online) 2019; 25(3): 82-86

TYPE I BRUGADA PATTERN IN THE RECOVERY PHASE OF THE EXERCISE STRESS TEST

DOI: 10.29327/22487.25.3-3

ABSTRACT

Brugada syndrome (BS) is one of the most common channelopathies, with a worldwide prevalence of 0.05%. It is estimated that it accounts for 4% of all cardiac sudden deaths and most patients are diagnosed only after the arrhythmic event. It is possible to find the Type I pattern by evaluating the electrocardiogram (EKG), characterized by an elevation of 2mm in the concave ST segment morphology in right precordial leads, followed by a negative T wave and the Type II pattern, defined by an elevation of 2mm in the ST segment morphology with a saddle shape followed by a positive or biphasic T wave. Recent studies demonstrate that, even in asymptomatic patients, the arrhythmic events rate rage from 0.5 – 1% per year, which makes it challenging and controversial to identify which individuals among those would have a greater chance to present ventricular arrhythmia, and consequently would benefit from the implantable defibrillator. In this context, the stress test, useful in diagnostic definition of patients with intermittent or even occult electrocardiographic pattern, has been shown to have some relevance in prognostic stratification. Below, a case of an oligosymptomatic patient known to have the intermittent Brugada Type I pattern, and who sought our service to perform a exercise stress test is reported. The patient presented a resting ECG with precocious repolarization patterns, without any other relevant alterations, evolving to a classic Brugada type I during the recovering stage. After the case description, considerations regarding the relevance of the finding and possible clinical implications were made.