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Brugada ECG Pattern Unmasked by IV Flecainide in an Individual with Idiopathic Fascicular Ventricular Tachycardia.

Gavin AR, Young GD, McGavigan AD - Indian Pacing Electrophysiol J (2013)

Bottom Line: He had previously been diagnosed with idiopathic fascicular ventricular tachycardia.Intravenous flecainide results in termination of his tachycardia but unmasks a latent type 1 Brugada ECG pattern not seen on his resting ECG.We discuss his subsequent management and the need to consider an alternative diagnosis in individuals with a Brugada type ECG pattern who present with stable monomorphic ventricular tachycardia.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Medicine, Flinders Medical Centre.

ABSTRACT
A 45-year old man presents with stable monomorphic ventricular tachycardia. He had previously been diagnosed with idiopathic fascicular ventricular tachycardia. Intravenous flecainide results in termination of his tachycardia but unmasks a latent type 1 Brugada ECG pattern not seen on his resting ECG. We discuss his subsequent management and the need to consider an alternative diagnosis in individuals with a Brugada type ECG pattern who present with stable monomorphic ventricular tachycardia.

No MeSH data available.


Related in: MedlinePlus

(A) Classical left posterior fascicular VT with right bundle branch block pattern and superior axis. (B) Resting ECG with no ST elevation. (C)Type 1 Brugada ECG pattern with coved ST elevation and J point elevation in leads V1 and V2 following administration of intravenous flecainide. (D) Recordings taken at time of EPS during VT. Sweep speed of 100mmm/sec. Displayed (from top) are 4 leads from ECG, 2 intracardiacelectrograms from quadripolar catheter at the His position and 2 recordings from mapping catheter (Map) in the region of the posterior fascicle. A high frequency short duration Purkinje potential (arrows) is seen preceding the onset of the QRS.
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Figure 1: (A) Classical left posterior fascicular VT with right bundle branch block pattern and superior axis. (B) Resting ECG with no ST elevation. (C)Type 1 Brugada ECG pattern with coved ST elevation and J point elevation in leads V1 and V2 following administration of intravenous flecainide. (D) Recordings taken at time of EPS during VT. Sweep speed of 100mmm/sec. Displayed (from top) are 4 leads from ECG, 2 intracardiacelectrograms from quadripolar catheter at the His position and 2 recordings from mapping catheter (Map) in the region of the posterior fascicle. A high frequency short duration Purkinje potential (arrows) is seen preceding the onset of the QRS.

Mentions: A 45-year old man presented with sudden onset palpitations whilst exercising. There was no associated hemodynamic compromise. Electrocardiogram (ECG) showed monomorphic ventricular tachycardia (VT) with a right bundle branch block pattern and a superior axis (Figure 1A).


Brugada ECG Pattern Unmasked by IV Flecainide in an Individual with Idiopathic Fascicular Ventricular Tachycardia.

Gavin AR, Young GD, McGavigan AD - Indian Pacing Electrophysiol J (2013)

(A) Classical left posterior fascicular VT with right bundle branch block pattern and superior axis. (B) Resting ECG with no ST elevation. (C)Type 1 Brugada ECG pattern with coved ST elevation and J point elevation in leads V1 and V2 following administration of intravenous flecainide. (D) Recordings taken at time of EPS during VT. Sweep speed of 100mmm/sec. Displayed (from top) are 4 leads from ECG, 2 intracardiacelectrograms from quadripolar catheter at the His position and 2 recordings from mapping catheter (Map) in the region of the posterior fascicle. A high frequency short duration Purkinje potential (arrows) is seen preceding the onset of the QRS.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539402&req=5

Figure 1: (A) Classical left posterior fascicular VT with right bundle branch block pattern and superior axis. (B) Resting ECG with no ST elevation. (C)Type 1 Brugada ECG pattern with coved ST elevation and J point elevation in leads V1 and V2 following administration of intravenous flecainide. (D) Recordings taken at time of EPS during VT. Sweep speed of 100mmm/sec. Displayed (from top) are 4 leads from ECG, 2 intracardiacelectrograms from quadripolar catheter at the His position and 2 recordings from mapping catheter (Map) in the region of the posterior fascicle. A high frequency short duration Purkinje potential (arrows) is seen preceding the onset of the QRS.
Mentions: A 45-year old man presented with sudden onset palpitations whilst exercising. There was no associated hemodynamic compromise. Electrocardiogram (ECG) showed monomorphic ventricular tachycardia (VT) with a right bundle branch block pattern and a superior axis (Figure 1A).

Bottom Line: He had previously been diagnosed with idiopathic fascicular ventricular tachycardia.Intravenous flecainide results in termination of his tachycardia but unmasks a latent type 1 Brugada ECG pattern not seen on his resting ECG.We discuss his subsequent management and the need to consider an alternative diagnosis in individuals with a Brugada type ECG pattern who present with stable monomorphic ventricular tachycardia.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Medicine, Flinders Medical Centre.

ABSTRACT
A 45-year old man presents with stable monomorphic ventricular tachycardia. He had previously been diagnosed with idiopathic fascicular ventricular tachycardia. Intravenous flecainide results in termination of his tachycardia but unmasks a latent type 1 Brugada ECG pattern not seen on his resting ECG. We discuss his subsequent management and the need to consider an alternative diagnosis in individuals with a Brugada type ECG pattern who present with stable monomorphic ventricular tachycardia.

No MeSH data available.


Related in: MedlinePlus