ECG Case 221 Interpretation

This post is an answer to the ECG Case 221

  • Rate: 66 bpm
  • Rhythm:Regular Sinus rhythm
  • Axis: LAD
  • Intervals:
    • PR – Normal (~200ms)
    • QRS – Normal (100ms)
    • QT – 400ms (QTc Bazette ~ 430 ms)

  • Segments:
    • ST elevation with coved morphology in leads V1 (2mm) and V2 (~3mm)
    • Upsloping ST depression in leads II, III, aVF, V4-6
  • Additional:
    • T wave inversion in leads V1, V2, aVR
    • Partial RBBB
    • Movement artefact obscures partially leads aVR, aVF, aVL
Brugada Type 1 Pattern
Brugada Type 1 Pattern


Brugada Type 1 Pattern

What happened next?

The patient was admit to the Coronary Care Unit, continuous telemetary did not capture any episodes of arrhythmia. Investigation of alternate causes of syncope were performed with normal echo, negative troponins, and normal CT head.

The patient underwent ICD implantation, with a Boston Scientific Incepta Single Chamber ICD, and at ICD insertion VF was inducible on right ventricular long burst.

READ MORE: Pearls in Syncope ECG Interpretation