case_images: PMC10850375_01
case_images: (Panel A) At baseline: show the spontaneous type 2 BrS pattern in IV intercostal space (ST-segment elevation of 2 mm in the right precordial leads followed by a convex ST) and presence of J-wave in II intercostal space. (Panel B) During ajmaline test: confirming the diagnosis of BrS during ajmaline infusion at 5 min and displaying a dST-Tiso of 340 ms. (Panel C) During ajmaline test: showing a T-wave alternans due to alternating activation during ajmaline infusion at 7 min (black arrows). (IIs-IIIs-IVs indicate chest electrodes position in basal condition and during ajmaline infusion: II-III-IV intercostal space). dST-Tiso is obtained measuring the interval between the onset of the coved ST-segment elevation and its termination at the level of the isoelectric line in V2 IIIs and V2 IVs leads.
case_images: fcvm-11-1304404-g001.jpg
case_images: PMC10850375_01_fcvm-11-1304404-g001.jpg
case_images: F1
case_images: We studied a 48-year-old man with BrS ECG type-2 pattern and presence of J-wave (Figure 1, Panel A) without a family history of SCD but with a previous syncope. After gaining informed consent, the novel ECG marker denoted "dST-Tiso interval" was assessed and appeared to be 340 ms (Figure 1, Panel B). T-wave alternans due to alternating activation during ajmaline infusion at 7 min was documented (Figure 1, Panel C). The T-wave morphology in the patient with BrS, exhibiting multiple ajmaline-induced electrogram fluctuations, reveals a notable reliance on the strength of epicardial activation.