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We report on the remote arrhythmia monitoring of a 34-year-old man with highly symptomatic Brugada syndrome, who initially presented with syncope, paroxysmal atrial fibrillation, and spontaneous coved-type electrocardiogram. The patient received a dual-chamber implantable cardioverter-defibrillator (ICD) with Home Monitoring™ facilities and experienced recurrent ICD shocks for spontaneous ventricular fibrillation (VF) episodes during the first year after ICD implantation. Remote monitoring revealed an increased burden of premature ventricular complexes and atrial arrhythmias each time VF spontaneously occurred. Atrial and ventricular arrhythmias were effectively suppressed by low-dose quinidine without severe side effects.

We discuss the electrocardiogram and differential diagnosis of an apparent type II second-degree atrioventricular block recorded in a 15-year-old girl after successful radiofrequency ablation of a left-sided concealed accessory pathway.

The diagnosis of Brugada syndrome (BS) is based on a combination of clinical (malignant arrhythmias presenting as syncopal or sudden death episodes) and electrocardiographic (pathognomonic ST segment elevation morphology) features. Over the last 15 years, since its introduction as a distinct clinical entity, the BS has been extensively investigated worldwide. In this article an overview of recent developments concerning the genetic background, the diagnostic tools and the therapeutic alternatives will be presented. In the last years, the results of the first medium-term follow-up studies have also been published. Some of these studies present contradictory results, especially concerning the identification of useful sudden death predictors in asymptomatic patients. The review presented here will discuss this prognostic controversy and will offer possible explanations for the different results.