A Case of Brugada Syndrome Presenting Very Slow Paroxysmal Supraventricular Tachycardia

Perspective from E-journals in J-STAGE

Abstract

A 24-years-old man who had recurrent syncope was diagnosed as Brugada syndrome at another hospital. He refused an implantable cardiac defibrillator and left the hospital. He suffered discomfort and palpitation just after discharge and, was taken to our hospital. The ECG showed paroxysmal supraventricular tachycardia（PSVT）with slow rate of 99 bpm. The tachycardia recurred despite administration of antiarrhythmic drugs. After hospitalization at our hospital, an electrophysiological study was performed. The PSVT was an orthodromic atrioventricular reentrant tachycardia（AVRT）with a left lateral concealed accessory pathway. The long AH interval during the tachycardia might affect the long cycle length of the PSVT. In addition, three antegrade pathways are thought to exist because of the two series of jump-up phenomena. The AVRT was not induced after the ablation of accessory pathway, but a Slow-Fast type of atrioventricular reentrant tachycardia（AVNRT）was induced under isoproterenol infusion. Slow pathway ablation was successfully performed. The coexistent Brugada syndrome and AVRT and AVNRT is rare. A sodium channel dysfunction in Brugada syndrome might affect the abnormal electrical conduction at atrio-His bundle lesion, which would lead to initiate and maintain the AVRT and AVNRT.