Transient Type 1 Brugada ECG Pattern in a Patient With Severe Coronary Artery Disease

A type 1 Brugada electrocardiographic (ECG) pattern is characteristic of Brugada syndrome but may also occur in association with reversible clinical conditions, including myocardial ischaemia.We describe a 49year-old man with type 2 diabetes mellitus, severe hypercholesterolaemia and a strong family history of premature ischaemic heart disease who presented with crescendo angina.His admission ECG demonstrated a type 1 Brugada pattern, with subsequent ECGs showing dynamic anterior ischaemic changes.Coronary angiography demonstrated extensive multivessel coronary artery disease, and the patient underwent urgent surgical revascularisation following Heart Team discussion.Serial postoperative ECGs demonstrated complete resolution of the type 1 pattern despite continuation of his regular medication, including mirtazapine.In the absence of arrhythmic syncope, documented ventricular arrhythmia, previous cardiac arrest or a family history of sudden cardiac death, sodium-channel blocker provocation testing was not pursued.Although latent Brugada syndrome cannot be definitively excluded, the temporal relationship between myocardial ischaemia, revascularisation and ECG normalisation supports an ischaemia-associated Brugada phenotype.