A Case of the Brugada Syndrome Necessitating Eight Years for ICD Therapy of Syncope with Convulsion

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This case is 52 years old man, and had not electrocardiogram (ECG) abnormalities in his medical check-up. He experienced a syncopal attack with tonic convulsion of the upper extremities after alcohol drinking, 8 years ago. Brain CT and electroencephalography revealed any intracranial disorders, whereas ST segment elevation in lead V1-2 was recorded in ECG. Because ST segment was significantly augmented with flecainide injection, electrophysiological (EP) test was performed. Any ventricular tachyarrhythmias were not provoked and he had not sudden cardiac death family history. Thus, the ICD implantation indication was classified into IIb and he rejected implantation of ICD and also implantable loop recorder (ILR) planned for long term monitoring. After 8 years, he was referred to our hospital because of snoring and loss of consciousness with convulsion, during which ventricular fibrillation (VF) was recorded. ICD was implanted for secondary prevention of sudden cardiac death. It needs long term observation for decision of ICD implantation in a patient with indication class IIb for ICD implantation, in whom the role of ILR should be discussed.
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