An electrocardiogram that changed destiny: Incidental Brugada with spontaneous evolution. Clinical case, Alcívar Hospital.

Abstract

Introduction: Brugada syndrome is an autosomal dominant genetic condition, more common in men. It presents a significant risk, as up to 80% of patients are asymptomatic before experiencing sudden death. The 10-year risk of serious arrhythmias is 12%. Early detection and risk stratification are essential in deciding whether an implantable cardioverter-defibrillator (ICD) is necessary.

Clinical Case: A 34-year-old man with no cardiovascular risk factors was found to have a brother who died at age 36 from unknown causes. During pre-surgical evaluation for inguinal herniorrhaphy, a Brugada type II pattern was observed on the ECG. The patient was asymptomatic and denied experiencing syncope. A subsequent Holter monitor showed a spontaneous transition to a type I Brugada pattern. Echocardiography revealed a structurally normal heart. Prognostic scores were applied: Shanghai scale: 4.5 points (definitive diagnosis); Sieira scale: 4 points (moderate risk). After risk assessment for sudden death, ICD implantation was recommended.

Discussion: Several prognostic scales exist, such as Shanghai and Sieira, but there is no consensus on a single scale with superior validity. The Sieira scale demonstrated a better balance between sensitivity and specificity than the Shanghai scale. The spontaneous change of the Brugada pattern (from type II to type I in this case) warrants a more detailed risk assessment. ICD remains the most effective life-saving treatment for patients with Brugada syndrome, though it carries a significant risk of complications.