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KMID : 1011920140150010044
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International Journal of Arrhythmia
2014 Volume.15 No. 1 p.44 ~ p.47
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A case of ventricular fibrillation: Brugada syndrome, early repolarization syndrome, or a variant?
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Nam Gi-Byoung
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Abstract
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Idiopathic ventricular fibrillation (VF) is diagnosed after exclusion of structural heart diseases and other known ion channelopathies. A 23-year-old male patient was resuscitated after sudden cardiac arrest due to VF. VF was defibrillated using an automated external defibrillator during transport to our emergency department. Electrocardiograms (ECGs) obtained at the coronary care unit showed prominent J waves in the right precordial V2 lead. The J waves were not followed by ST-segment elevation or T-wave inversion, and thus were distinct from the typical ECG changes in Brugada syndrome. The results of the laboratory and imaging studies were within normal limits. A flecainide provocation test failed to reveal Brugada-type ECG changes. Under the diagnosis of idiopathic VF, a cardioverter-defibrillator was implanted. Follow-up ECGs obtained at the outpatient clinic showed a spontaneous fluctuation of J waves that coincided with the VF episodes, strongly suggesting that the J waves were pathophysiologically linked to the VF events. In this paper, we discuss the diagnostic ambiguity in variants of idiopathic VF and propose an expanded concept of the J-wave syndrome.
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KEYWORD
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ventricular fibrillation, early repolarization, J wave
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