Increased heart rate and shortening of the coupling intervals of the first cycles before the tachycardia are due to a change in the vagosympathetic balance with an increased sympathetic tone. This increase appears to be the main determinant of the ventricular tachycardia in this disease in contrast to the multifactorial origin of ventricular tachycardia due to coronary heart disease. It should be considered in patients participating in strenuous athletic activities.

We report the case of a patient with genetically confirmed Brugada syndrome who presented with ST-segment elevation in the right precordial and inferior leads. The presenting arrhythmia was atrial fibrillation, which degenerated into ventricular fibrillation during intravenous amiodarone. A flecainide test was markedly positive. Four appropriate cardioverter-defibrillator discharges occurred during a two-year follow-up period after implantation of the device.

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