Bisenić Vesna, Hinić Saša, Krotin Mirjana, Milovanović Branislav, Šarić Jelena, Milašinović Goran
Srp Arh Celok Lek. 2012 Jan-Feb;140(1-2):84-90. doi: 10.2298/sarh1202084b.
Brugada syndrome is an arrhythmogenic disease characterized by coved ST segment elevation and J point elevation of at least 2 mm in at least two of the right precordial ECG leads (V1-3) and ventricular arrhythmias, syncope, and sudden death. Risk stratifications of patients with Brugada electrocardiogram are being strongly debated.
A 23-year-old man was admitted to the Coronary Care Unit of the Clinical Centre "Bezanijska kosa" due to weakness, fatigue and chest discomfort. The patient suffered from fainting and palpitations. There was a family history of paternal sudden death at 36 years. Electrocardiogram showed a coved ST segment elevation of 4 mm in leads V1 and V2, recognised as spontaneous type 1 Brugada pattern. Laboratory investigations revealed normal serum cardiac troponin T and serum potassium, and absence of inflammation signs. Echocardiographic finding was normal, except for a mild enlargement of the right atrium and ventricle. The diagnosis of Brugada syndrome was made by Brugada-type 1 electrocardiogram and the family history of sudden death <45 years. The patient was considered as a high risk, because of pre-syncope and palpitations. He underwent ICD implantation (Medtronic MaximoVR7232Cx) using the standard procedure. After implantation, noninvasive electrophysiology study was done and demonstrated inducible VF that was interrupted with the second 35 JDC shock. The patient was discharged in stable condition with beta-blocker therapy. After a year of pacemaker check-ups, there were no either VT/ VF events or ICD therapy.
Clinical presentation is the most important parameter in risk stratification of patients with Brugada electrocardiogram and Brugada syndrome.
Brugada综合征是一种致心律失常性疾病，其特征为右胸前区至少两个心电图导联（V1 - 3）出现下斜型ST段抬高和J点抬高至少2毫米，以及室性心律失常、晕厥和猝死。Brugada心电图患者的风险分层一直存在激烈争论。
一名23岁男性因虚弱、疲劳和胸部不适入住“贝扎尼什卡科萨”临床中心的冠心病监护病房。患者曾有昏厥和心悸症状。有家族史，其父亲36岁时猝死。心电图显示V1和V2导联下斜型ST段抬高4毫米，被识别为自发1型Brugada图形。实验室检查显示血清心肌肌钙蛋白T和血清钾正常，且无炎症迹象。超声心动图检查结果正常，除右心房和右心室轻度增大外。根据1型Brugada心电图和45岁以下猝死家族史，诊断为Brugada综合征。由于患者有先兆晕厥和心悸症状，被视为高危患者。他接受了ICD植入（美敦力MaximoVR7232Cx），采用标准程序。植入后，进行了无创电生理研究，结果显示可诱发室颤，第二次35焦耳直流电电击终止了室颤。患者在接受β受体阻滞剂治疗后病情稳定出院。起搏器检查一年后，未发生室性心动过速/室颤事件，也未进行ICD治疗。
临床表现是Brugada心电图和Brugada综合征患者风险分层中最重要的参数。
