case_images: PMC11176425_01
case_images: (A) The electrocardiogram of the young female patient showing ventricular fibrillation during resuscitation initially. (B) After achieving recovery of spontaneous circulation, the sinus rhythm soon degenerated into polymorphic ventricular tachycardia again.
case_images: fcvm-11-1406614-g001.jpg
case_images: PMC11176425_01_fcvm-11-1406614-g001.jpg
case_images: F1
case_images: Taiwan, initially presented to the neurological outpatient department with recurrent episodes of syncope with an upward eye deviation, which had been noticed over a period of two years. The routine awake electroencephalogram (EEG) revealed focal epileptiform discharges over the left temporal region (Supplementary Figure S1), suggesting epileptic seizure. Cardiopulmonary resuscitation was initiated, with initial rhythm exhibiting ventricular fibrillation (VF) (Figure 1A). However, the cardiac rhythm of the patient degenerated into polymorphic ventricular tachycardia (VT) (Figure 1B), requiring further cardiac defibrillations.
case_images: (A) A baseline 12-lead ECG of the patient showed a Brugada type 2 pattern (saddleback ST-segment elevation) in the precordial leads V1 placed at 4th ICS and lead V2 placed at 4th ICS. (B) About four minutes after the IV ajmaline injection, a Brugada type 1 pattern (coved-type ST-segment elevation) appeared in all precordial and high intercostal leads (V3-V6). Of note, lead V3 at the right 3rd ICS and lead V4 were placed at the left 3rd ICS, whereas lead V5 at right 2nd ICS and lead V6 were placed at the left 2nd ICS, respectively. ICS, intercostal space.
case_images: fcvm-11-1406614-g002.jpg
case_images: PMC11176425_01_fcvm-11-1406614-g002.jpg
case_images: F2
case_images: After tapering the overdrive pacing, repeat ECGs showed saddleback ST segment elevation in precordial leads V1-V3, suggestive a Brugada type 2 pattern (Figure 2A). Serial ECGs showed a typical Brugada type 1 ECG pattern in the pericardial standard and high intercostal leads (Figure 2B), thus confirming the diagnosis of BrS in this young female patient.