Inappropriate ICD shock occurred 34 years after the last syncope in a symptomatic Brugada patient: does arrhythmia risk shift from VF to AF with age in Brugada syndrome?

Atrial fibrillation (AF) is a significant cause of inappropriate implantable cardioverter defibrillator (ICD) shocks. A male patient in his 70s was diagnosed with Brugada syndrome (BrS) in his 40s following ventricular fibrillation-induced syncope. He had implanted a single-lead ICD in his 50s. 34 years after the last syncope, the ICD delivered four inappropriate shocks due to paroxysmal AF, successfully treated with pulmonary vein isolation. Ageing likely increased AF burden, despite its infrequency during follow-up. This case highlights the limitations of single-lead ICDs in AF detection and the importance of tailored management in elderly BrS patients.