Atrial fibrillation associated with Wolff-Parkinson-White syndrome in a patient with concomitant Brugada syndrome

Figures

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  Figure 1. Proband’s ECGs before ablation. A: Baseline ECG shows positive delta waves in leads I, II, aVL, and V1–V6 and negative delta waves in leads in leads III and aVF. B: One episode of atrial fibrillation in the presence of an accessory pathway recorded before ablation. Black arrows indicate concomitant type 1 Brugada ECG. ECG = electrocardiogram.

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  Figure 2. Follow-up ECGs of the proband after ablation. After radiofrequency catheter ablation, the regular ECG displays disappearance of delta waves and onset of coved-type ST-segment elevation followed by negative T waves in leads V1 and V2 in 2 days (A). One month (B) later, it shows a type 2 Brugada pattern in the fourth ICS and a typical type 1 Brugada pattern in the second ICS. A similar ECG pattern is discovered after 9 and 12 years (C & D). ECG = electrocardiogram; F-U = follow-up; ICS = intercostal space.

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  Figure 3. Summary of the genetic information and medical history of the family. A: Family pedigree of the index case. B: Baseline ECG of proband’s youngest brother (II-7) in 4th ICS (left) and 2nd ICS (right) in 2004 who suffered from sudden cardiac death in 2013. C: DNA chromatogram of SCN5A-WT and SCN5A-R1193Q. The latter is discovered in the index case and his family member. D: Landmark events during follow-up for the family. ICS = intercostal space.