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 <i>SCN5A</i> 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, <i>pectus excavatum</i>, 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.