Transient appearance of Brugada-like Type 1 electrocardiogram pattern immediately after biphasic synchronized electrical cardioversion for atrial fibrillation: a case series

ST-segment deviation post-electrical cardioversion is a common finding amongst a significant number of patients. However, the mechanism by which this phenomenon occurs and its clinical implications are not fully understood.

Four patients presented to our department with complaints of palpitations. They were found to have atrial fibrillation and were cardioverted using a synchronized direct current shock at 200 J. However, their telemetry immediately after the shock showed transiently an ST-segment elevation resembling Brugada Type 1 pattern. All telemetries normalized within 6 s from cardioversion.

Through this report, we aim to raise mild concern about a possible safety issue related to synchronized electrical cardioversion with electrodes positioned in an anteroposterior fashion. Also, we try to give a pathophysiological explanation to this finding on the base of the knowledge accumulated through the years on Brugada syndrome.