PMC5420017_01
Electrocardiogram taken just after cardiac defibrillation. The traces show sinus rhythm and a resemblance to a type 1 pattern.
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After a brief period of atrial fibrillation, sinus rhythm spontaneously resumed and a 12-lead ECG showed a transient late coved wave in V1-V2 (Figure 1).
Flecainide challenge. a: At baseline electrocardiogram (ECG) with right precordial leads V1-V2 placed at the fourth intercostal space. Marked left axis deviation is present, but not type 1 ECG. b: After flecainide a type 1 ECG is present with some late QRS fragmentation. c: After flecainide with V1-V2 placed at the third intercostal space. d: After flecainide with V1-V2 placed at the second intercostal space.
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A flecainide challenge test (2 mg/kg injected over 10 minutes) was performed 5 days after the aborted cardiac arrest and resulted in a Brugada type 1 ECG pattern with late QRS fragmentation in V1 but no S wave in lead 1 (Figure 2).
Contrast magnetic resonance imaging study of the left ventricle: delayed enhancement (suggesting fibrosis) of the inferior-basal left ventricular wall at the insertion of the posterior papillary muscle (arrow).
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A patchy fibrosis of the inferobasal wall of the left ventricle, at the insertion of the papillary muscle, was ascertained by contrast-enhanced cardiac MRI (Figure 3).