Clinical presentation and electrocardiographic features of Brugada syndrome in Iraq

Abstract

Background: Brugada syndrome is a clinical entity composed of twelve leads electrocardiographic changes of coved or saddle shaped STsegment elevation in V1 and V2 with serious ventricular arrhythmias which may cause sudden cardiac death. Objectives: The objectives of this study is to highlight the clinical presentation and the types of ECG changes of Brugada syndrome cases seen in Iraq and to orient physicians about this fatal condition. Patients and Methods: Patients presented with symptoms of palpitation, dizzy attacks or syncope and diagnosed as Brugada syndrome were included in this case series study. The diagnosis of Brugada syndrome based mainly on the typical coved or saddle shaped or variant STSegment elevation in electrocardiographic leads V1, V2. Results: Eighteen patients were included in this case series study. All are males. Age ranged from 15-45 Y. The presenting symptoms were palpitation in 12 patients, syncope in 8, dizzy spells and pre syncope in 14 and chest pain seen in 2. The arrhythmic events were clinically documented in 10. Monomorphic VT seen in 4, VF in 2, atrial fibrillation in 2 and atrial flutter in 2. Induced VF by EP study seen in 2. Type I Brugada ECG pattern was seen in 6 patients, type II in 4 and three of type III. Five showed a variant type of the syndrome. Family history of sudden cardiac death was seen in 8 patients while in 10 it was negative. ICD was implanted in 6 patients. In 12 patients (67%) the diagnosis of Brugada syndrome was missed during the provisional medical contacts. Conclusion: Brugada syndrome is not uncommon in Iraq but needs a high diagnostic suspicion through appreciating the symptomologies and electrocardiographic features of this fatal syndrome to plan management to prevent sudden cardiac death.