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Europace 2007 9(3):172-174; doi:10.1093/europace/eum002
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

VENTRICULAR FIBRILLATION

Brugada-like electrocardiographic pattern and ventricular fibrillation in a patient with primary hyperparathyroidism

Lung-Sheng Wu1, Chia-Tung Wu1, Lung-An Hsu1, Nazar Luqman2 and Chi-Tai Kuo1,*

1 Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 199, Tunhwa N. Road, Taipei, Taiwan, Republic of, China; 2 Department of Cardiology, RIPAS Hospital, Bander Seri Begawan, Brunei Darussalam

There are several causes for ST segment abnormalities in leads V1 to V3. Hypercalcaemia and Brugada syndrome are among them. Both are known to produce ventricular arrhythmia, albeit only rare cases have been reported with documented evidence of ventricular arrhythmias in association with a hypercalcaemic crisis but none when hypercalcaemic coexists with Brugada syndrome. We describe a patient with primary hyperparathyroidism who presented with ventricular fibrillation, and the ECG showed changes similar to Brugada syndrome. The provocation test with flecainide was conducted twice. This was positive, both before and after parathyroidectomy when serum calcium and parathormone levels had normalized. The patient was treated for hypercalcaemia and underwent parathyroidectomy. This is the first report of oral flecainide test unmasking the diagnostic coved Brugada ECG pattern in a patient with primary hyperparathyroidism and raising attention to hypercalcaemia as a potential trigger for life-threatening arrhythmia in Brugada syndrome.

Key Words: Ventricular fibrillation, Hyperparathyroidism, Hypercalcaemia, Brugada syndrome

* Corresponding author. Tel: +886 33281200 ext.8162; fax: +886-33271192. E-mail address: chitai{at}adm.cgmh.org.tw

Manuscript submitted 20 July 2006. Accepted after revision 17 December 2006.


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