Diagnosis and management of Brugada Syndrome Unmasked by Flecainide challenge in a patient with unexplained ventricular fibrillation: a case report

Introduction Brugada syndrome is a genetic disorder associated with sudden cardiac death (SCD) due to ventricular fibrillation (VF). The diagnosis relies on detecting a Type 1 ST-segment elevation in the right precordial leads, which often requires sodium channel blocker provocation for confirmation. Patient concerns: We present a case of a 55-year-old male bus driver who experienced out-of-hospital cardiac arrest due to VF. Diagnosis: After resuscitation, initial evaluations, including echocardiography and cardiac enzyme tests, were normal, showing no structural heart disease. The initial electrocardiogram displayed a Type 2 Brugada pattern. Intervention: A flecainide challenge test using oral flecainide (300 mg) revealed a Type 1 Brugada pattern, confirming Brugada syndrome. Outcomes: Despite mild hypokalemia, an implantable cardioverter defibrillator (ICD) was implanted due to the patient’s high-risk occupation and VF history. Conclusion: This case underscores the importance of considering Brugada syndrome in unexplained VF cases and highlights the role of flecainide testing in diagnosis. A multidisciplinary approach, including thorough evaluation, timely ICD implantation, and patient education, is crucial for optimal outcomes, particularly for those in safety-critical professions. Recognizing Brugada syndrome and applying appropriate diagnostic and therapeutic measures are essential for preventing fatal arrhythmic events. Learning points