Ventricular fibrillation in Graves disease reveals a rare SCN5A mutation with W1191X variant associated with Brugada syndrome

Figures

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  Figure 1. Initial electrocardiogram.

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  Figure 2. A: Telemetry events prior to ventricular fibrillation (VF) arrest. Normal sinus rhythm at an initial rate of 90–100 beats/min. There are frequent preceding premature ventricular contractions (asterisk), which are almost identical to the initiating premature ventricular complexes of VF. B: Electrocardiogram immediately post arrest showing irregular wide complex bradyarrhythmia.

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  Figure 3. A: Follow-up electrocardiogram showing a ≥0.5 mm convex ST-segment elevation in lead V1 concerning for the nondiagnostic type 2 “saddle-back” Brugada pattern. B: Pedigree structure of patient’s family. Circles indicate females; squares indicate males. Numbers beside each symbol represent the individual’s age in years. Text adjacent to each symbol indicates the significant medical history for each individual. Filled symbols indicate individuals with sudden cardiac death presumed to be related to W1191X mutation. Symbols with a crossed line indicate deceased individuals, with the cause of death listed in the adjacent text. The proband (our patient) is marked by an arrow and the letter “P.” CVA = cerebrovascular accident; DM2 = diabetes mellitus type II; HTN = hypertension; Lung Ca = lung cancer; MI = myocardial infarction; MVA = motor vehicle accident; SD = sudden death.