Journal of Rare Cardiovascular Diseases

Sports‑associated sudden cardiac arrest (SCA) constitutes an important problem. Causes of SCA during sport activities include Brugada syndrome (BrS) among others. We describe a 29‑year‑old male, without a history of cardiovascular disease, who suffered from SCA during football training and despite intensive treatment, after almost 4 weeks of hospitalization, unfortunately died. Detailed medical documentation review showed grade I atrioventricular block, intraventricular conduction abnormalities and BrS type 2 morphology of ST-segment elevation on resting 12‑lead electrocardiogram (ECG). The patient had a history of syncope during physical activity. Further echocardiographic study did not reveal significant structural heart disease. Submaximal exercise testing was performed and showed ventricular extrasystoles during physical activity and type 1 BrS morphology of ST-segment elevation during recovery phase. We compared observed ECG changes to those present in a healthy football player and described noticeable similarities. Exercise ECG testing, especially in patients after syncope of probable arrhythmic etiology, may unmask BrS ECG pattern and lead to BrS diagnosis. JRCD 2017; 3 (3): 92–97.

Brugada syndrome; exercise ECG; electrocardiogram; rare disease

Marijon E, Uy‑Evanado A, Reinier K, et al. Sudden cardiac arrest during sports activity in middle age. Circulation 2015; 131: 1384–1391.

Podolec P. Classification of rare cardiovascular diseases. J Rare Cardiovasc Dis 2013; 1: 49–60.

Campbell RM, Berger S, Drezner J. Sudden cardiac arrest in children and young athletes: the importance of a detailed personal and family history in the pre‑participation evaluation. Br J Sports Med 2009; 43: 336–341.

Priori SG, Blomstrom‑Lundqvist C, Mazzanti A, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 2015; 36: 2793–2867.

Bayes de Luna A, Brugada J, Baranchuk A, et al. Current electrocardiographic criteria for diagnosis of Brugada pattern: a consensus report. J Electrocardiol 2012; 45: 433–442.

Jayasuriya C, Whitman M. Exercise‑induced Brugada sign. Europace 2011; 13: 446–447.

Amin AS, de Groot EA, Ruijter JM, et al. Exercise‑induced ECG changes in Brugada syndrome. Circ Arrhythm Electrophysiol 2009; 2: 531–539.

Orlowska‑Baranowska E, Baranowski R, Hryniewiecki T. Incidence of syncope and cardiac arrest in patients with severe aortic stenosis. Pol Arch Med Wewn 2014; 124: 306–312.

Lee L, Khawcharoenporn T, Chokrungvaranon N, et al. Takotsubo cardiomyopathy associated with syncope. Heart Lung 2009; 38: 163–166.

Sosnowska‑Pasiarska B, Bakowski D, Woronowicz‑Chrosciel A, et al. Sudden cardiac arrest in takotsubo cardiomyopathy – a case study. Postepy Kardiol Interwencyjnej 2014; 10: 110–113.

Kukla P, Hybel J, Bednarek J, et al. [Polymorphic ventricular tachycardia with a short coupling interval in a patient with normal heart–a case report]. Kardiol Pol 2004; 60: 586–590.

Chandra N, Bastiaenen R, Papadakis M, et al. Sudden cardiac death in young athletes: practical challenges and diagnostic dilemmas. J Am Coll Cardiol 2013; 61: 1027–1040.

Holcman K, Rubiś P, Wiśniowska‑Śmiałek S, et al. A 33‑year‑old man after sudden cardiac arrest as a first manifestation of Brugada syndrome. J Rare Cardiovasc Dis 2016; 2: 220–224.

Drezner JA, Fischbach P, Froelicher V, et al. Normal electrocardiographic findings: recognising physiological adaptations in athletes. Br J Sports Med 2013; 47: 125–136.

Serra G, Baranchuk A, Bayes‑De‑Luna A, et al. New electrocardiographic criteria to differentiate the Type‑2 Brugada pattern from electrocardiogram of healthy athletes with r’-wave in leads V1/V2. Europace 2014; 16: 1639–1645.

Matusik PT. Insights into channelopathies: progress in clinical practice and research. J Electrocardiol 2017; 50: 534–535.

Maron BJ, Zipes DP, Kovacs RJ. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Preamble, Principles, and General Considerations: A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol 2015; 66: 2343–2349.

Grimster A, Segal OR, Behr ER. Type I Brugada electrocardiogram pattern during the recovery phase of exercise testing. Europace 2008; 10: 897–898.

Makimoto H, Nakagawa E, Takaki H, et al. Diagnostic and prognostic value of augmented ST‑segment elevation at exercise testing in patients with Brugada syndrome. Circulation 2008; 118 (Suppl. 2): S674.

Ruta J, Kawinski J, Ptaszynski P, et al. [Abnormal filter setting or Brugada syndrome?]. Kardiol Pol 2013; 71: 1192–1193.

Gottschalk B, Anselm DD, Baranchuk A. Brugada phenocopy: morphological classification and importance of provocative testing. Ann Noninvasive Electrocardiol 2014; 19: 604–605.

Gottschalk BH, Garcia‑Niebla J, Anselm DD, et al. New methodologies for measuring Brugada ECG patterns cannot differentiate the ECG pattern of Brugada syndrome from Brugada phenocopy. J Electrocardiol 2016; 49: 187–191.

Bugajski J, Sacha J. Brugada electrocardiography pattern caused by Taxus poisoning. Kardiol Pol 2015; 73: 463.

Jankiewicz S, Blaszyk K, Mularek‑Kubzdela T, et al. [ST segment elevation typical for Brugada syndrome after intracoronary acetylocholine injection with retrosternal pain in history]. Kardiol Pol 2012; 70: 80–83; discussion 84.

Siniorakis E, Arvanitakis S, Prokovas E, et al. Brugada sign unmasking the location of an acute myocardial infarction. Kardiol Pol 2010; 68: 708–710, discussion 711.

Mont L, Pelliccia A, Sharma S, et al. Pre‑participation cardiovascular evaluation for athletic participants to prevent sudden death: Position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. Eur J Prev Cardiol 2017; 24: 41–69.

American College of Sports Medicine, Sawka MN, Burke LM, et al. American College of Sports Medicine position stand. Exercise and fluid replacement. Med Sci Sports Exerc 2007; 39: 377–390.

Pelliccia A, Fagard R, Bjornstad HH, et al. Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group

of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 2005; 26: 1422–1445.

Ackerman MJ, Zipes DP, Kovacs RJ, et al. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 10: The Cardiac Channelopathies: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation 2015; 132: e326‑329.

Hammond‑Haley M, Patel RS, Providencia R, et al. Exercise restrictions for patients with inherited cardiac conditions: Current guidelines, challenges and limitations. Int J Cardiol 2016; 209: 234–241.