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A 50-year-old woman with dextrocardia and D-transposition of the great arteries presented with a “RV defib lead impedance” remote-monitoring alert from her implantable cardioverter defibrillator (ICD). In 2012, she had a ventricular fibrillation cardiacarrest. An epicardial pacemaker was implanted.
This ECG pattern may be diagnostic of B rugada S yndrome IF seen in association with: i ) a history of cardiacarrest; polymorphic VT; or of non-vagal syncope; and / or ii ) a positive family history of sudden death at an early age; and / or iii ) a similar ECG in relatives. Cardioversion/defibrillation. Acute febrile illness.
In addition to a spontaneous or induced Brugada-1 ECG pattern, criteria for B rugada S yndrome require one or more of the following: History of cardiacarrest, of polymorphoic VT, or of non-vagal syncope — positive family history of sudden death at an early age — a similar ECG in close relatives. Circulation, 117, 1890–1893. [3]:
J Electrocardiology 45 (2012):433-442. Further history later: This patient personally has no further high risk features (syncope / presyncope), but her mother had sudden cardiacarrest in sleep. Bayes de Luna, A et al. Current electrocardiographic criteria for diagnosis of Brugada pattern: a consensus report.
The patient was unconscious BEFORE the cardiacarrest, at the same time that she had strong pulses. Therefore, cardiacarrest is NOT the etiology of the coma. More cases here to highlight: [link] Middle Aged Woman with Asystolic CardiacArrest, Resuscitated: Cath Lab? OMI is a clinical diagnosis.
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