Europace (2008) 10, 897–898 doi:10.1093/europace/eun101
IMAGES IN ELECTROPHYSIOLOGY
Type I Brugada electrocardiogram pattern during the recovery phase of exercise testing Alexander Grimster, Oliver R. Segal*, and Elijah R. Behr Cardiological Sciences, St George’s Hospital, Blackshaw Road, London SW17 0QT, UK Received 29 February 2008; accepted after revision 31 March 2008; online publish-ahead-of-print 28 April 2008
KEYWORDS Brugada syndrome; Sudden death; Channelopathy; Exercise testing; Repolarization
exercise, a drop in blood pressure associated with dizziness occurred consistent with a vasovagal episode. Two and a half minutes into the recovery phase, the ECG pattern changed to a classical type I Brugada ECG morphology with coved ST-segment elevation in the precordial chest leads. These changes reverted to baseline over the subsequent 12 min. Implantable cardioverter defibrillator implantation was offered. Normalization of ST-segment elevation in the Brugada syndrome has been described during exercise testing. Unmasking of type I Brugada ECG in the recovery phase of exercise
Figure 1 ST segment changes during recovery phase of exercise.
* Corresponding author. Tel: þ44 20 8672 1255. E-mail address:
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Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2008. For permissions please email:
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A 33-year-old Algerian man presenting with acute asthma was found to have right bundle branch block and anterior ST-segment elevation on surface electrocardiogram (ECG). Two years earlier he had suffered a syncopal event during which relatives were unable to find a pulse. A brother had died suddenly with acute asthma. Exercise tolerance testing was performed (Figure 1). The resting supine ECG morphology is consistent with Brugada type II ECG pattern with ‘saddleback’ ST-elevation in leads V2 and V3. During 13 min of exercise, T-wave inversion developed in V2 with a reduction in ST-segment elevation in V3. On cessation of
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testing has not been described. The mechanism for these changes is unknown, but appears similar to the exacerbation of the Brugada ECG seen with the administration of parasympathetic-stimulating agents. Exercise testing with close examination of the recovery phase should be
A. Grimster et al.
considered in the investigation of patients presenting with a type II Brugada ECG pattern and previous syncope and/or a family history for sudden death. Conflict of interest: none declared.
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