Zou Guangchen, Khanna Mukul, Zahid Saliha, Dengle Samir, Matta Bhavna, Zaheer Haris, Farrell Matthew, Stein Russell
Department of Internal Medicine, Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810, USA.
Department of Medicine, University of Vermont, Burlington, VT, USA.
Eur Heart J Case Rep. 2021 Nov 8;5(12):ytab454. doi: 10.1093/ehjcr/ytab454. eCollection 2021 Dec.
Pharmacologic challenge test is often used to diagnose Brugada syndrome (BrS) when spontaneous electrocardiograms (ECG) do not show type I Brugada pattern but reported sensitivity varies. The role of the exercise stress test in diagnosing Brugada syndrome is not well-established.
A patient had a type I Brugada pattern ECG during the recovery phase of exercise stress test but had a negative procainamide challenge test. He had a loop recorder implanted and later survived a ventricular fibrillation (VF) arrest provoked by coronavirus disease 2019 (COVID-19). Electrocardiogram on arrival showed type 1 Brugada pattern. He was discharged after implantable cardioverter-defibrillator implantation. He later underwent genetic testing and was found to be heterozygous for c.844C>G (p.Arg282Gly) mutation in the SCN5A gene.
Type 1 Brugada pattern ECG may be unmasked by ST-segment augmentation during recovery from exercise. Exercise stress test may play a role in the diagnosis of Brugada syndrome when suspicion for Brugada syndrome remains after a negative procainamide challenge test or if the patient has exercise-related symptoms. COVID-19 can unmask BrS and trigger a VF cardiac arrest.
当自发心电图（ECG）未显示I型Brugada波型时，药物激发试验常被用于诊断Brugada综合征（BrS），但报道的敏感性有所不同。运动负荷试验在诊断Brugada综合征中的作用尚未明确。
一名患者在运动负荷试验恢复期出现I型Brugada波型ECG，但普鲁卡因胺激发试验结果为阴性。他植入了环形记录仪，后来在2019冠状病毒病（COVID-19）引发的心室颤动（VF）骤停中存活。入院时的心电图显示为1型Brugada波型。植入植入式心脏复律除颤器后出院。他后来接受了基因检测，发现SCN5A基因存在c.844C>G（p.Arg282Gly）突变的杂合子。
运动恢复期ST段抬高可能会揭示出1型Brugada波型ECG。当普鲁卡因胺激发试验结果为阴性但仍怀疑患有Brugada综合征，或患者有与运动相关症状时，运动负荷试验可能在Brugada综合征的诊断中发挥作用。COVID-19可揭示BrS并引发VF心脏骤停。
