ECG of the Week - 22nd February 2016 - Interpretation

This ECG is from a 28 year old male who presented following an episode of syncope. he had no known medical problems, takes no regular medication and has no family history of collapse or sudden cardiac death.

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Rate:

• 84 bpm

Rhythm:

• Regular

Axis:

• Normal

Intervals:

• PR - Normal (~190ms)
• QRS - Normal (100ms)
• QT - 330ms (QTc Bazette 390 ms)

Segments:

• ST Elevation lead V2 ~2mm

Additional:

• Partial RBBB
• Left Atrial Abnormality
• Wide notched P wave in lead II
• Negative portion of P wave in V1 >40ms and >1mm

Interpretation:

• History of collapse in a young patient
• Partial RBBB and ST elevation in V2
• ? Brugada Syndrome with a Type 2 (non-diagnostic) pattern

What happened ?

The patient was admitted under the cardiology team for further investigation.

A cardiac MRI and echo were both normal.

Given the concern of possible Brugada the patient underwent a flecainide challenge which was negative, excluding Brugada syndrome as a cause of the patient's syncope.

An implantable loop recorder (ILR) was inserted to monitor for further arrhythmogenic events and the patient was discharge with out patient cardiology follow-up.

Brugada Syndrome

We've covered Brugada Syndrome in detail back in July 2013, check out that post here:

• ECG of the Week - 15th July 2013

More on Brugada here:

• The Cardiac Society of Australia and New Zealand Guidelines for the diagnosis and management of Brugada Syndrome 
• Life in the Fast Lane - Brugada Syndrome

References / Further Reading

Life in the Fast Lane

• Brugada Syndrome

Textbook

• Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.