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Europace Advance Access originally published online on November 24, 2007
Europace 2008 10(1):86-90; doi:10.1093/europace/eum244
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

BRUGADA SYNDROME

Pilsicainide-induced Brugada-type ECG and ventricular arrhythmias originating from the left posterior fascicle in a case with Brugada syndrome associated with idiopathic left ventricular tachycardia

Takeshi Ueyama1,*, Akihiko Shimizu2, Masahiro Esato1, Yasuhiro Yoshiga1, Akira Sawa1, Shinsuke Suzuki1, Naoki Sugi1 and Masunori Matsuzaki1

1 Division of Cardiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube 755-8505, Japan; 2 Division of Cardiology and Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan

The patient was a 50-year-old male in 2002, who was first suspected of having a Brugada-type electrocardiogram (ECG). A drug challenge test using pilsicainide was performed and unmasked a typical coved type ST elevation followed by ventricular arrhythmias (VAs) manifesting a QRS pattern with a right bundle branch block and left axis deviation. Three years later, he was transferred to the emergency room due to a wide QRS tachycardia with the same QRS morphology as the VA that previously occurred in the drug challenge test. An ECG just after the recorded termination of the tachycardia exhibited a typical Brugada-type ECG. In an electrophysiological study, ventricular fibrillation could be easily induced with reproducibility. Since the clinical tachycardia could not be sustained by an isoproterenol infusion, mapping and catheter ablation targeting the pilsicainide-induced VAs was performed. The successful ablation site was the left mid-lower septal wall where a Purkinje potential was recorded and a false tendon was attached just to it.

Key Words: Idiopathic ventricular tachycardia, Brugada syndrome, Pilsicainide

* Corresponding author. Tel: +81-836-22-2248; fax: +81-836-22-2246. E-mail address: ueyama23{at}yahoo.co.jp

Manuscript submitted 11 September 2007. Accepted after revision 8 October 2007.


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