Alcohol-induced ventricular fibrillation in a case of Brugada syndrome

A 25-year-old man lost consciousness while consuming alcohol, and cardiopulmonary resuscitation was performed. Twelve-lead electrocardiogram (ECG) in the emergency room showed sinus rhythm, but the patient lost consciousness during physical examination, and the ECG monitor showed ventricular fibrillation (VF), which was successfully cardioverted. The patient was transferred to our hospital, whereupon 12-lead ECG revealed type 1 Brugada syndrome (Figure 1). The patient had no history of syncope. Coronary angiography showed no coronary artery stenosis, and no significant coronary artery spasm was induced. Ventricular fibrillation was induced by double extrastimuli from the right ventricular outflow tract. An implantable cardioverter-defibrillator was inserted. The patient experienced two appropriate implantable cardioverter defibrillator (ICD) shocks, one at 5 months and one at 7 months after hospital discharge, both during alcohol consumption (Figure 1). In the second consensus conference report, alcohol intoxication was listed as sometimes responsible for a drug-induced Brugada-like ECG pattern, but no reference was given. To the best of our knowledge, there is only one report of a Brugada syndrome patient who experienced appropriate ICD shocks after alcohol consumption. The exact mechanism of alcohol-induced VF in Brugada syndrome is not clear; increased parasympathetic nervous activity might be related to the triggering of VF. The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/Documents/alcohol-induced.pdf