Case series of Type 1 Brugada pattern provoked by exercise: a role for diagnostic treadmill stress testing

Brugada syndrome (BrS) is a rare cardiovascular condition that can lead to life-threatening arrhythmias. The SCN5A gene, most implicated in heritable BrS, is found in only 20% of those who have the clinical phenotype seen with BrS. Establishing the diagnosis of BrS can be challenging as the electrocardiogram (ECG) pattern that is diagnostic for the syndrome is often transient. Typically, a pharmacological challenge using a Class 1 antiarrhythmic is used to provoke a Type 1 Brugada pattern on ECG that may otherwise be concealed.

We describe a case series of three unrelated patients who underwent an exercise treadmill test (ETT) according to standard Bruce protocol. Each patient demonstrated a Type 1 Brugada pattern most apparent in the early recovery phase immediately after peak exercise but not at baseline.

This case series highlights the value of ETT as a diagnostic aid for BrS. We suggest that ETT could be considered as a routine means of provoking a Brugada ECG pattern.