Unmasking the Brugada syndrome with high parasternal leads

Abstract

A 37-year-old man underwent implantation of a defibrillator in 1996 for ‘idiopathic ventricular fibrillation’ (nocturnal sudden death in the absence of heart disease). Retrospective examination of all standard electrocardiograms recorded since then showed intermittent repolarization abnormalities. These were of the ‘saddle-back’ (type II) morphology of Brugada syndrome. The typical coved-type (type I) pattern of Brugada syndrome became evident only when placing standard V1–V3 leads on the 1st, 2nd and 3rd right parasternal spaces and V4–V6 on the left parasternal spaces ( Figure 1 ), as first suggested by Shimizu et al.1 Right (RP) and left (LP) high parasternal leads compared with standard V1 and V2 leads.