Ventricular Fibrillation Induced by Hyperventilation in a Patient with Brugada Syndrome

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A 71-year-old man with a history of Sleep Apnea Syndrome (SAS) was admitted to our hospital because of recurrent syncopal episode. Hyperventilation test in electroencephalography (EEG) was performed suspected of epilepsy. Ventricular fibrillation (VF) suddenly occurred during the test, and was immediately converted to sinus rhythm without resuscitation. His electrocardiogram (ECG) at rest showed normal sinus rhythm with coved-type ST-segment elevation in leads V1 and V2. The coronary angiogram revealed no stenotic lesion. We observed that recurrent VF was reproduced by hyperventilation test. He underwent coronary spasm provocation test. The right coronary and the conus branch were occluded and further ST-segments elevation of V1 to V3 were observed after the right coronary injection of acetylcholine. Several coexistent cases of Brugada syndrome and vasospastic angina have been reported in Japan. This case suggested that hyperventilation might lead to VF easily in patients with Brugada syndrome accompanied by vasospastic angina.