A Shock to the Heart? A Case of Phantom Shocks in a Patient with Brugada Syndrome

Brugada syndrome is an inherited condition characterized by an increased risk of sudden cardiac death (SCD) secondary to lethal ventricular arrhythmias occurring most often in the fourth decade of life. Implantable cardioverter-defibrillators (ICDs) are recommended in patients who have documented ventricular tachycardia (VT) or ventricular fibrillation (VF) and in patients presenting with a spontaneous type 1 Brugada pattern on electrocardiogram (ECG) and a history of arrhythmic-sounding syncope.1 However, patients with ICDs are at risk of developing “phantom shocks” which occur when a patient reports the sensation of receiving a shock that is not confirmed upon subsequent device interrogation.2 One retrospective study of 38 patients demonstrated that patients who reported phantom shocks had a higher prevalence of documented depression, anxiety and substance use and that patients who had previous ICD shocks for “arrhythmia storm” were more likely to experience phantom shocks.3 Prior studies have described the increased incidence of anxiety and decreased quality of life in patients diagnosed with Brugada syndrome alone with some patients developing post-traumatic stress disorder (PTSD).4 We present a case of a patient with previously diagnosed Brugada syndrome who suffered from phantom shocks after a defibrillation event. This case highlights the importance of recognizing phantom shocks for improving patient outcomes, to provide a multidisciplinary approach and to optimize both cardiac and psychological well-being of these patients.