Near fatal ventricular fibrillation in Brugada syndrome despite presence of an implanted implantable cardioverter defibrillator.

A 38-year-old man with Brugada syndrome and aborted cardiac arrest was treated with quinidine only, based on the results of electrophysiologic drug testing. Six months later, after suffering a vaso-vagal syncope, he opted to receive an implantable cardioverter defibrillator and decided to discontinue quinidine against our recommendation. Sixty-seven months later, he had recurrent ventricular fibrillation that was terminated only by the sixth maximal energy shock delivered by the device (which has the capability to deliver a maximum of 8 shocks). This case suggests the possible risk in only relying on an implantable cardioverter defibrillator in the management of cardiac arrest survivors with Brugada syndrome.