Key result
Procainamide challenge and EPS unmask type 1 Brugada pattern in baseline type 2 ECG.
Why the study?
Most patients with Brugada syndrome are asymptomatic, and diagnosing concealed forms often requires provocative testing with sodium channel blockers.
Case Report (n=1)
This case demonstrates the utility of a two-stage diagnostic algorithm using a procainamide challenge test and electrophysiological study to unmask concealed type 1 Brugada syndrome and stratify arrhythmic risk.
May support sequential testing for concealed Brugada; leaves open prospective validation before wider adoption.
Brugada syndrome is a hereditary channelopathy associated with a high risk of life-threatening ventricular arrhythmias in individuals without structural heart disease. Its prevalence is 1-5 per 10,000 persons, and most patients are asymptomatic; diagnosis of concealed forms is often possible through provocative testing with sodium channel blockers. We report a case of a 53-year-old male patient K., in whom type 2 Brugada-like ECG changes were incidentally detected during an emergency medical services call for nausea, vomiting, and diarrhea. A Brugadalike pattern in leads V1-V2 persisted on repeated ECG recordings. After exclusion of coronary artery disease, a procainamide challenge test was performed and yielded a positive result with induction of a type 1 pattern. The patient was referred to a specialized center, where endocardial electrophysiological study (EPS) confirmed a procainamide-induced type 1 Brugada pattern. This case demonstrates the value of a complete twostage diagnostic algorithm for individualized arrhythmic risk stratification.
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Borisov et al. (2026) conducted a case report in Brugada syndrome (procainamide-induced type 1 Brugada pattern) (n=1). Procainamide challenge test and endocardial electrophysiological study (EPS) was evaluated on Induction and confirmation of type 1 Brugada pattern. Procainamide challenge testing and subsequent endocardial electrophysiological study induced and confirmed a type 1 Brugada pattern in a 53-year-old man with baseline type 2 ECG changes.
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