Oxf Med Case Reports. 2026 Jan 28;2026(1):omaf301. doi: 10.1093/omcr/omaf301. eCollection 2026 Jan.
ABSTRACT
INTRODUCTION: Brugada syndrome is a genetic disorder associated with sudden cardiac death (SCD) due to ventricular fibrillation (VF). The diagnosis relies on detecting a Type 1 ST-segment elevation in the right precordial leads, which often requires sodium channel blocker provocation for confirmation. Patient concerns: We present a case of a 55-year-old male bus driver who experienced out-of-hospital cardiac arrest due to VF. Diagnosis: After resuscitation, initial evaluations, including echocardiography and cardiac enzyme tests, were normal, showing no structural heart disease. The initial electrocardiogram displayed a Type 2 Brugada pattern. Intervention: A flecainide challenge test using oral flecainide (300 mg) revealed a Type 1 Brugada pattern, confirming Brugada syndrome. Outcomes: Despite mild hypokalemia, an implantable cardioverter defibrillator (ICD) was implanted due to the patient's high-risk occupation and VF history. Conclusion: This case underscores the importance of considering Brugada syndrome in unexplained VF cases and highlights the role of flecainide testing in diagnosis. A multidisciplinary approach, including thorough evaluation, timely ICD implantation, and patient education, is crucial for optimal outcomes, particularly for those in safety-critical professions. Recognizing Brugada syndrome and applying appropriate diagnostic and therapeutic measures are essential for preventing fatal arrhythmic events.
LEARNING POINTS: This case underscores the importance of considering Brugada syndrome in patients with unexplained ventricular fibrillation, emphasizing the utility of the flecainide challenge test for accurate diagnosis when characteristic ECG findings are not evident.A multidisciplinary approach, including timely diagnosis, appropriate ICD implantation, and patient education, is critical in managing high-risk occupations to prevent catastrophic outcomes.
PMID:41613391 | PMC:PMC12850529 | DOI:10.1093/omcr/omaf301