First description of a Brugada phenocopy in the inferior leads in the context of an acute inferior myocardial infarction

A 67-year-old male patient with no prior medical cardiac history presented to the emergency department with anginal chest pain lasting for 1 h. His electrocardiographic (ECG) revealed ST-segment elevation in leads II, III, and aVF (Figure, A). A diagnosis of acute inferior myocardial infarction was made and the patient was transferred to our Cath Lab for a coronary angiography that revealed right coronary artery (RCA) occlusion in the mid segment and 50% stenosis of the circumflex artery (CX). Personal or family history of unexplained syncope, sudden cardiac death, or implantable cardiac defibrillator implantation was denied. Initial blood tests were normal except increased high sensitive troponin I: 24.98 ng/mL (0.002–0.0342). The patient presented polymorphic ventricular tachycardia (VT) with haemodynamic deterioration (Figure B). He was successfully defibrillated. Following defibrillation, the ECG revealed typical type-1 Brugada pattern in leads II, III, and aVF (Figure C). Electrolytes were normal and the patient was not receiving any medication known to trigger a Brugada ECG pattern. A new coronary angiogram showed a patent stent to the RCA and no progression of the CX lesion. The ECG normalized spontaneously immediately after the angiogram (Figure, D). A provocative test with ajmaline was performed 2 days later which failed to induce a type-1 Brugada ECG pattern. The full-length version of this report can be viewed at: http://www.escardio.org/Guidelines-&-Education/E-learning/Clinical-cases/Electrophysiology/EP-Case-Reports.