We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Case Report/Case Series |

Brugada Syndrome Presenting as Polymorphic Ventricular Tachycardia–Ventricular Fibrillation Lasting 94 Seconds Recorded on an Ambulatory Monitor

Christopher R. Russo, MD1; Terrence D. Welch, MD1; Rajbir S. Sangha, MD1; Mark L. Greenberg, MD1
[+] Author Affiliations
1Section of Cardiology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
JAMA Intern Med. 2015;175(12):1951-1954. doi:10.1001/jamainternmed.2015.5934.
Text Size: A A A
Published online


Importance  Cardiac arrhythmias are common causes of syncope. Brugada syndrome is an uncommon but serious genetic arrhythmia disorder that can be unmasked by medicines causing sodium channel blockade.

Observations  This report documents a case of Brugada syndrome and polymorphic ventricular tachycardia–ventricular fibrillation not initially recognized in a patient taking nortriptyline and experiencing syncope. It also illustrates one of the longest episodes of ventricular fibrillation recorded on an ambulatory monitor (94 seconds). Although the baseline electrocardiogram did not demonstrate a typical appearance for Brugada syndrome, provocative testing with flecainide in this patient with documented polymorphic ventricular tachycardia revealed a Brugada electrocardiogram pattern.

Conclusions and Relevance  Vigilance should be maintained for arrhythmia substrates such as Brugada syndrome in patients with typical symptoms when they are prescribed membrane-active medicines. Long-term ambulatory rhythm monitors can provide useful information in these cases, especially when symptoms are infrequent.

Figures in this Article


Place holder to copy figure label and caption
Figure 1.
A Single 94-Second Polymorphic Ventricular Tachycardia–Ventricular Fibrillation Event Captured on the Ambulatory Monitor (Continuous Recording Across 2 Pages)
Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
The Initial 12-Lead Electrocardiogram From the Second Emergency Department Visit
Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
The 12-Lead Electrocardiogram After Flecainide Challenge
Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles