1264

Abstract

Case Reports: Brugada syndrome (BS), a rare condition that places patients at increased risk of cardiac arrest, is characterized by three specific ECG patterns in the precordial leads. This syndrome is a genetic disorder inherited through an autosomal dominant mutant gene and is thought to be responsible for up to twenty percent of sudden cardiac deaths in those without structural heart disease. Prevention has been directed at avoidance of drugs that block the sodium channels and implanting ICDs when indicated. Because Brugada syndrome can present as cardiac arrest, therapeutic hypothermia has been proposed as an option to improve neurological outcomes in those who arrest; however, there is limited and controversial data on its utility. We report a case of Brugada syndrome in which “normalization” of the ECG occurred acutely following initiation of therapeutic hypothermia.A 36 year old Caucasian gentleman, with no significant past medical history, had an out of hospital cardiac arrest with basic life support provided by his wife. He had no history of syncope, alcohol or illicit drug use and was employed as a custodian. His family history was positive for sudden death of his father while swimming at age 32. On EMS arrival, he was found to be in pulseless ventricular fibrillation and was defibrillated three times before return of spontaneous circulation. Therapeutic hypothermia was initiated by EMS. On arrival to the hospital his blood pressure was 173/136 but had otherwise stable vital signs. He was subsequently intubated and sedated. On exam he had a fixed split S2 and an ECG revealing an incomplete right bundle branch block, ST segment elevation in leads V1-V3 with saddleback appearance. Initial labs revealed a troponin of 0.01, CK-MB of 2.1, WBC 16.1, bicarb of 15 with an arterial blood gas pH of 7.14, pCO2 of 40, and pO2 of 424. His ECG abnormalities resolved during therapeutic hypothermia. An echocardiogram revealed mild concentric left and right ventricular hypertrophy, normal wall motion and ejection fraction, and no valvular abnormalities. Cardiac catheterization revealed mild coronary artery disease involving the left circumflex and left anterior descending arteries, not requiring any intervention. He made a full recovery and underwent AICD placement prior to discharge.Sudden cardiac arrest is often the initial clinical manifestation of Brugada syndrome. Because of the critical nature of these patients, methods for improving neurological function post arrest are needed. Hypothermia has been used in experimental models to produce the J-ST segment elevation so it had been hypothesized that the syndrome would worsen during hypothermia. However, in our patient therapeutic hypothermia normalized these findings. Our patient had a good clinical outcome following treatment with therapeutic hypothermia due to Brugada syndrome.