Electrocardiographic changes in STEMI with Brugada syndrome.

DESCRIPTION : We report a sequence of ECGs recorded in a 61-yearold man admitted to a primary care hospital for a persistent chest pain. The patient was diagnosed 3 years ago for an asymptomatic Brugada type 1 syndrome (SCN5A Gly752Arg variant) as illustrated by the coved ST-segment elevation in the right precordial leads followed by a negative T wave (Panel A). He did not show positive evidence of sudden death in his family history. Although, his father died at age 38 in a car accident in unclear circumstances. The first ECG recorded in the emergency department showed an inferior STEMI with ST-segment elevation in the inferior leads (DII, DIII, aVF), posterior extension as demonstrated by a marked ST-segment depression in V1-V2 partially masking the electrocardiographic aspect of the Brugada pattern, and complete atrioventricular block (Panel B). Afterward, the patient developed malignant ventricular arrhythmias successfully treated by electrical cardioversion (Panel C). The ECG recorded after a thrombolytic reperfusion therapy showed the resurgence of the Brugada electrical abnormalities as previously observed before the right coronary occlusion (Panel D). [...]