Ventricular fibrillation arrest due to Brugada syndrome in a coronavirus disease 2019 patient with negative procainamide challenge: a case report

Guangchen Zou; Mukul Khanna; Saliha Zahid; Samir Dengle; Bhavna Matta; Haris Zaheer; Matthew Farrell; Russell Stein

doi:10.1093/ehjcr/ytab454

Ventricular fibrillation arrest due to Brugada syndrome in a coronavirus disease 2019 patient with negative procainamide challenge: a case report

Eur Heart J Case Rep. 2021 Nov 8;5(12):ytab454. doi: 10.1093/ehjcr/ytab454. eCollection 2021 Dec.

Authors

Guangchen Zou^{1

2}, Mukul Khanna³, Saliha Zahid^{1

2}, Samir Dengle³, Bhavna Matta^{1

2}, Haris Zaheer^{1

2}, Matthew Farrell⁴, Russell Stein³

Affiliations

¹ Department of Internal Medicine, Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810, USA.
² Department of Medicine, University of Vermont, Burlington, VT, USA.
³ Department of Cardiology, Danbury Hospital, Danbury, CT, USA.
⁴ Ross School of Medicine, Miramar, FL, USA.

Abstract

Background: Pharmacologic challenge test is often used to diagnose Brugada syndrome (BrS) when spontaneous electrocardiograms (ECG) do not show type I Brugada pattern but reported sensitivity varies. The role of the exercise stress test in diagnosing Brugada syndrome is not well-established.

Case summary: A patient had a type I Brugada pattern ECG during the recovery phase of exercise stress test but had a negative procainamide challenge test. He had a loop recorder implanted and later survived a ventricular fibrillation (VF) arrest provoked by coronavirus disease 2019 (COVID-19). Electrocardiogram on arrival showed type 1 Brugada pattern. He was discharged after implantable cardioverter-defibrillator implantation. He later underwent genetic testing and was found to be heterozygous for c.844C>G (p.Arg282Gly) mutation in the SCN5A gene.

Discussion: Type 1 Brugada pattern ECG may be unmasked by ST-segment augmentation during recovery from exercise. Exercise stress test may play a role in the diagnosis of Brugada syndrome when suspicion for Brugada syndrome remains after a negative procainamide challenge test or if the patient has exercise-related symptoms. COVID-19 can unmask BrS and trigger a VF cardiac arrest.

Keywords: Brugada syndrome; COVID-19; Case report; Exercise stress test; Procainamide challenge; Ventricular fibrillation.

Publication types

Case Reports