Exercise stress test unmasking a Brugada pattern in a survivor of cardiac arrest: a case report

TL;DR

A young man who survived cardiac arrest during exercise showed a Brugada pattern only during peak stress testing, suggesting exercise may help diagnose this arrhythmic disorder.

Contribution

This case report highlights the rare occurrence of a Brugada Type 1 ECG pattern during peak exercise stress testing.

Findings

A treadmill stress test revealed a diagnostic Brugada Type 1 ECG pattern during peak exercise in a cardiac arrest survivor.

The resting ECG was non-diagnostic, and no other causes of cardiac arrest were identified.

The case suggests exercise stress testing may aid in diagnosing Brugada syndrome and re-evaluating sports participation guidelines.

Abstract

Brugada syndrome (BrS) is a hereditary arrhythmic disorder associated with an increased risk of ventricular arrhythmias (VA) and sudden cardiac death (SCD). Certain triggers may unmask the diagnostic high-risk BrS Type 1 electrocardiographic (ECG) pattern. However, conversion to a Type 1 pattern during peak exercise testing is uncommon. Despite the established benefits of physical activity, exercise in patients with inherited arrhythmia syndromes may provoke malignant arrhythmias. Current guidelines allow for some degree of sports participation in asymptomatic individuals with BrS, including mutation carriers and athletes with only an inducible ECG pattern.

We describe a case of a young man who survived a cardiac arrest during physical exertion. A treadmill stress test revealed a diagnostic Type 1 BrS ECG pattern at peak exercise. The resting ECG was non-diagnostic, and comprehensive evaluation excluded other causes of cardiac arrest.

In BrS, VA most commonly occur at rest, during sleep, or during exercise recovery, when vagal tone is predominant. This case demonstrates that BrS Type 1 ECG changes may also be elicited during peak sympathetic stimulation, such as intense exercise. This rare presentation suggests that exercise stress testing could play a role in the diagnostic and risk stratification process in selected patients with suspected BrS. Furthermore, it raises questions regarding the safety of physical activity in this population and whether current recommendations on sports participation warrant re-evaluation in light of such findings.

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