Late Potential at the High Ventricular Septal Level in a patient with Brugada: Possible mechanisms and Clinical implications
Case report
A 34-year-old Mexican immigrant was referred for symptomatic paroxysmal atrial fibrillation. A baseline electrocardiogram (ECG) in sinus rhythm showed type 1 Brugada pattern with right bundle branch block and negative T waves as well as ST-segment elevation in V1-V3. The patient had no prior history of ventricular arrhythmia, syncope, or cardiac arrest. However, a positive family history of sudden cardiac death (brother died at age 20) prompted referral to our service for further risk
Discussion
Ventricular late potentials and wide and fractionated electrograms, which reflect delayed and fragmented ventricular conduction, have been reported in both the epicardium 1and endocardium 2of patients with Brugada syndrome (BS). Marked regional endocardial conduction delay and heterogeneities in repolarization exist in these patients. 3There is an emerging notion that the arrhythmogenesis of BS is not only attributable to abnormal electrophysiologic properties but also requires the conspiring
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