Syncope and "Normal" ECG: Is Brugada Syndrome the Culprit?

Brugada syndrome (BrS) is an inherited disorder associated with a risk of ventricular fibrillation (VF) and sudden cardiac death (SCD) in a structurally normal heart mainly in young males, related to pathogenic variants in the SCN5A gene. There are three electrocardiographic patterns in BrS that must be identified, being diagnostic only type 1 pattern (coved J-point elevation >2 mm with a negative T-wave in V1 to V3). However, other circumstances can lead to a type 1 Brugada-like ECG, such as atypical right bundle branch block, pectus excavatum, arrhythmogenic right ventricular cardiomyopathy, acute coronary syndromes (occlusion of the left anterior descending artery or the conus branch of the right coronary artery), hypokalemia/hyperkalemia and cocaine poisoning, when present, these conditions are known as Brugada phenocopies, and it is imperative to rule out these conditions. We present the case of a young man with syncope with an initial suspected "normal" electrocardiogram with posterior development of type 1 Brugada pattern and an episode of non-sustained ventricular tachycardia.