This post is also available in: Italiano (Italian)

Today, i read a tale told by Dr. Sergio Pinski on twitter.

I found it so interesting and meaningful that that i wanted to share it here.

Dr. Pinski wrote:

“A tale of Brugada. Or the Law of Unintended Consequences.

A 40 yo Afro-Caribbean laborer received a dual-chamber ICD in 2002 for a marked Brugada pattern. He was asymptomatic and had no family history of sudden death.

The Fidelis lead fractured and he received multiple spurious shocks in 2004.
The left subclavian vein was closed.
They placed a second Fidelis lead from the right side, tunneled to the left pocket.

The second Fidelis fractured in 2009. He received 48 spurious shocks.
The ICD was turned off.
Patient developed a florid post traumatic stress disorder.

He first came to see me shortly thereafter, very distressed.
He wanted everything out.
The ECG pattern fluctuated. These are CXR and ECG in 2009:

I thought extraction was a little risky, at least in my hands.
I recommended a second opinion from one of the gurus of lead extraction.
Patient declined. He chose to keep device in and off.

He has checked with me every few years.
It took him long time to recover from post-traumatic stress, but he did.
He is 57 now, asymptomatic and in good health.
Leads and depleted device still in, This is current ECG:

I’m afraid the description of the Brugada Syndrome has resulted in net harm to humankind, especially outside Southeast Asia. “

Today, the only gold standard for the diagnosis of Brugada syndrome, is the presence of typical ECG and typical symptoms. In some of the rare cases of “True” Brugada Syndrome, the onset of the disease may be the fatal event.

However, equating an ECG to a Syndrome, as well as being semantically incorrect, is leading to deleterious consequences that any subject with a Brugada type 1 ECG pattern is considered to be at risk of sudden cardiac death,
both in the presence and in the absence of symptoms.

The real challenge, today, it is able to identify with certainty those who, among asymptomatic subjects, carriers of characteristic ecg, are at real risk, avoiding to submit at invasive and risky treatment, the majority of those who find themselves having simply “a strange ecg”! [1][2]

To each its thinking…


[1] Delise P., et. al, Brugada type 1 electrocardiogram: Should we treat the electrocardiogram or the patient? World J Cardiol. 2017 Sep 26; 9(9): 737–741.

[2] Martini B., et al, A rare lethal syndrome in search of its identity: Sudden death, right bundle branch block and ST segment elevation

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