Exercise ECG unmasked Brugada sign: manifestation of the risk of sports-associated sudden cardiac arrest (RCD code: V-1A.1)

Abstract

Sports-associated sudden cardiac arrest (SCA) constitutes an important problem. Causes of SCA during sport activities include Brugada syndrome (BrS) among others. We describe a 29-year-old male, without a history of cardiovascular disease, who suffered from SCA during football training and despite intensive treatment, after almost 4 weeks of hospitalization, unfortunately died. Detailed medical documentation review showed grade I atrioventricular block, intraventricular conduction abnormalities and BrS type 2 morphology of ST-segment elevation on resting 12-lead electrocardiogram (ECG). The patient had a history of syncope during physical activity. Further echocardiographic study did not reveal significant structural heart disease. Submaximal exercise testing was performed and showed ventricular extrasystoles during physical activity and type 1 BrS morphology of ST-segment elevation during recovery phase. We compared observed ECG changes to those present in a healthy football player and described noticeable similarities. Exercise ECG testing, especially in patients after syncope of probable arrhythmic etiology, may unmask BrS ECG pattern and lead to BrS diagnosis. JRCD 2017; 3 (3): 92-97

Pathogenesis and Management of Brugada Syndrome: Recent Advances and Protocol for Umbrella Reviews of Meta-Analyses in Major Arrhythmic Events Risk Stratification

“…Our research outcome will hopefully advance our understanding of BrS risk stratification for efficient diagnosis and treatment approaches, and potentially reduce SCD risk by timely interventions such as ICD placement [ 63 ] or epicardial catheter ablation of the RVOT [ 64 ]. Our umbrella reviews may promote early detection, prevention, and counselling of patients with BrS, who might be susceptible to MAE events triggered by alcohol, fever, heavy meals, specific types of exercise, cocaine, and selected drugs [ 9 , 11 , 45 ]. Our proposed umbrella reviews will provide a valuable summary of and supplement to meta-analytical research in the scientific community for clinical practice.…”

“…This may appear spontaneously or following intravenous drug provocation with class Ia (ajmaline or procainamide) or class Ic (flecainide or pilsicainide) sodium channel blockers [ 28 ]. The BrS type 1 ECG pattern may also be induced by fever and exercise tests [ 8 , 9 , 10 , 11 , 45 ]. The unique ECG pattern is often short-lasting, and only depending on standard 12-lead ECG may lead to underdiagnosis of 65% patients, especially those who need modified high leads or drug provocation [ 9 ].…”

Abnormal ECG Findings in Athletes: Clinical Evaluation and Considerations

“…In such cases, we suggest repeating the ECG with placement of leads V1 and V2 in the 2nd intercostal space. The conversion of the type 2 pattern to the type 1 pattern with this measure is an indication for confirming the diagnosis with a provocation test with a sodium channel blocking agent [39,[66][67][68].…”

Brugada syndrome: new concepts and algorithms in management (RCD code: V 1A.1)

“…In a systematic literature review, Masrur et al report only 18 articles concerning BrS and exercise, including 16 case reports and 2 larger studies about exercise testing in BrS patients [38]. No exercise-related sudden death was reported in the above mentioned review, however, a recent case report of SCA during training in a competitive football player without previous BrS diagnosis was described [44].…”