Korean Circ J.  2007 Oct;37(10):517-519. 10.4070/kcj.2007.37.10.517.

An Unusual Case of Exercise-Induced Idiopathic Brugada Electrocardiographic Pattern

• Cho JH
• Cho DK
• Choi JY
• Eun LY
• Cho YH
• Koh JH
• Byun KH

• KMID: 2227054
• DOI: http://doi.org/10.4070/kcj.2007.37.10.517

Abstract

An exercise-induced idiopathic Brugada electrocardiographic pattern during the effort phase is very rare. A 42-year-old male visited our cardiology clinic for chest discomfort. He has been treated for myocardial infarction 2 months ago. He underwent a treadmill test according to the Bruce protocol. Typical coved-type ST-segment elevation was found during the effort phase, and it gradually recovered after the exercise. The ST-segment elevation appeared to be unrelated to hypervagotonia. This elevation was not induced by a pharmacological test with flecainide. A significant ventricular arrhythmia was not induced by programmed ventricular stimulation. Hence, we discharged the patient without implantation of an implantable cardioverter defibrillator.

Keyword

Brugada ECG; Vagus nerve; Exercise test

MeSH Terms

Adult
Arrhythmias, Cardiac
Cardiology
Defibrillators
Electrocardiography*
Exercise Test
Flecainide
Humans
Male
Myocardial Infarction
Thorax
Vagus Nerve
Flecainide

Figure

• 

  Fig. 1 Electrocardiogram (ECG) findings at emergency room. A: the ECG shows ST-segment elevation in V1-V3, thereby implying anterior wall myocardial infarction. B: during transfer, the patient suddenly developed ventricular fibrillation.

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  Fig. 2 Diagnostic coronary angiography at admission and follow-up coronary angiography. A: significant stenosis (arrow) was observed at the proximal third of the left anterior descending artery with plaque rupture. B: the patency of the previously inserted stent was determined by a follow-up coronary angiography, and no newly developed stenosis was observed. C: right coronary angiography revealed no significant luminal narrowing.

• 

  Fig. 3 Serial electrocardiogram (ECG) findings. A: resting ECG shows no ST-segment elevation in the precordial leads. B: coved-type ST-segment elevation (2 mm in V1 and 6 mm in V2) was observed during the effort phase. C: ST-segment elevation was normalized during the recovery phase. D: a flecainide infusion test (120 µg/min for 15 min) was performed. However, typical Brugada-like ECG pattern was not induced during this test.

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  Fig. 4 Electrocardiogram (ECG) of 12 leads determined at the effort phase. Coved-type ST-segment elevation in V1 and V2 (2 mm in V1 and 6 mm in V2) was observed without chest pain. However, no reciprocal changes were observed.

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