Brugada syndrome associated with an autonomic disorder

Abstract

A 44 year old man with Brugada syndrome and ventricular fibrillation had an autonomic disorder, shown by spectral analysis of heart rate variability and ¹²³I-MIBG myocardial scintigraphy. Periodic variation of the ST segments was detected by Holter ECG. Increased high frequency power (0.15-0.40 Hz), an index of parasympathetic nerve activity, was observed just before ST segment elevation. In addition, local dysfunction of sympathetic nerves in the left ventricle was detected by ¹²³I-MIBG myocardial scintigraphy. Unbalanced autonomic nerve function plays an important role in inducing Brugada-type ECG signs.

 Keywords: Brugada syndrome;  autonomic disorder;  ¹²³I-MIBG myocardial scintigraphy

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Figure 1  .

Standard 12 lead ECG on admission.

Figure 2  .

ST trendogram of Holter ECG and high frequency power obtained by analysis of spectral heart rate variability. ST segment elevation was observed in ST trendogram at 16:00 and 15:00 to 16:00. Before elevation of the ST segment, an increase in high frequency power, an index of parasympathetic nerve tension, was observed.

Figure 3  .

Myocardial scintigram using ^99mTc-MIBI (A) or ¹²³I-MIBG (B). In ^99mTc-MIBI myocardial scintigraphy, no abnormality was observed in myocardial blood flow; however, during early imaging of myocardial scintigraphy using ¹²³I-MIBG, a decreased accumulation or an unequal distribution of ¹²³I-MIBG was observed in part of the inferior wall, the apex, and anterior wall of the left ventricle; while in delay imaging, an increased wash out of ¹²³I-MIBG was observed in the inferior wall.