A case in which cardiac arrest after orthognathic surgery lead to a diagnosis of Brugada syndrome

We report a case of Brugada syndrome in which we observed IVF immediately after orthognathic surgery, performed defibrillation, and successfully resuscitated the patient. The patient was an 18-year-old male who was referred to our hospital with a chief complaint of mandibular retrusion. He was diagnosed with mandibular retrognathia, and simultaneous maxillomandibular advancement surgery and genioplasty were planned. During the initial consultation, it was revealed that the patient's grandfather had a history of heart bypass surgery and had died of unexplained cardiac arrest, but there was no significant medical history among the patient's parents. The patient himself had no history of palpitations or loss of consciousness. Preoperative ECG revealed sinus bradycardia. The anesthesiologist determined that surgery under general anesthesia was feasible, and the operation was performed. The surgery lasted 3 hours and 50 minutes, with a blood loss of 674 g. The surgery was completed without the occurrence of ventricular fibrillation. However, immediately after extubation, the patient experienced respiratory distress due to secretions and developed tachyarrhythmia. The tachycardia did not improve, and frequent ventricular fibrillation (VF) was observed, necessitating defibrillation. The VF did not reappear, and the patient was transferred to a general ward. However, on the third postoperative day, VF recurred, requiring defibrillation, and the patient was transferred to the ICU. On the 14th postoperative day, he was diagnosed with idiopathic ventricular fibrillation (IVF) by the cardiology department and had an implantable cardioverter-defibrillator (ICD) inserted.