ABC: časopis urgentne medicine (Jan 2015)
Recurrent episodes of ventricular tachycardia in a patient with Brugada syndrome was converted by implantable cardioverter defibrillator (ICD)
Abstract
INTODUCTION: Brugada syndrome (BS) is a genetic electric disorder without structural damage to the myocardium. ECG events are dynamic and diverse. Some conditions as hypo- and hyperkalemia, hypercalcemia, vagotonia, fever, etc. can induce the development of VT, VF and SCD (sudden cardiac death). ICD implantation for symptomatic patients with BS type 1 and unexplained syncope, VT or NSS is the treatment of choice. For all others, especially those asymptomatic, still has prognostic dilemmas. THE AIM: is to point out the importance of ICD implantation for symptomatic patients with BS. MATERIALS AND METHODS: We used a retrospective analysis of medical records of patient with BS in which the ICD have implanted because of life-threatening ventricular rhythm disorders. CASE REPORT: The young man, 17 years old, had palpitations and lost consciousness for two times. Emergency Medical Service (EMS) transported him to General Hospital of Vrbas without TA, with repetitive VT and fever. He converted with antiarrhythmic agents. On Institute for Cardiovascular Diseases (ICVD) of Vojvodina: ECG, ECHO and Holter rhythm at admission and discharge were within the limits. NMR has shown increase volume of RV and 2 focus dyskinesia of wall. Electrophysiological studies have shown frequent VES which induced VT easily. Attempts ablation of focus were without success. Catheterization and coronary angiography were normal. PH findings corresponded to the active myocarditis. Control EKG have suggested a BS. 3 years later after bathing in the river to repeated episodes of VT. Its converted and on ICVD of Vojvodina and him has implanted ICD. One year later he was admitted into ICVD due to frequent attacks VT which interrupted with ICD. The day before he had nausea with profuse vomiting (vagotonic) and hypokalemia. After correction K + ceased attacks of VT. A year later he came to the EMS of the Vrbas because a fever and irregular heartbeat. He was hypotensive and ECG showed sinus tachycardia, no new dynamics. During transport to the Cardiology of Vrbas, he had 10-odd episodes of VT that was interrupted with ICD, without loss of consciousness. The attacks of VT were stopped after correction the respiratory infection and fever and he was released back home after 10 days in good general condition. CONCLUSION: BS is one of the most common causes of SCD in patients with structurally normal hearts. Any patient with unexplained syncope requires consideration of BS. Each ECG changes in leads V1-4 can be BS, which can be unmasked by putting precordial leads I / II intercostal space more. All symptomatic patients with verified BS type 1 require immediate implementation of ICD, which is the only life-saving option.
