A 53-year-old man was referred to cardiology for an ECG abnormality discovered during an episode of left anterior chest pain. An exercise myocardial perfusion scan, echocardiogram, and chest X-ray were all normal. During 24-hour monitoring, the ECG abnormalities did not change:

• Type I Brugada ECG pattern

The patient underwent investigation showing no evidence of myocardial ischemia. His ST changes had remained unchanged, and were compatible with type I Brugada ECG pattern (2 mm or more J-point elevation in V1 and V2, with concave-upward ST elevation and negative T wave).

When he was 36, the patient had one brief witnessed episode of syncope, lasting about 5 seconds. He has had no loss of postural tone or symptoms suggestive of arrhythmias, and has no family history of unexpected sudden death.

The patient was assessed in the EP clinic. As he is a male and has a spontaneous type 1 Brugada, further risk stratification with an EP study to rule our inducible VT or VF was advised. However, the patient declined any further investigations.