Early Repolarization Pattern with the Huge and Tall Peaked T Wave as Clinical Suspicious Brugada Syndrome

Brugada syndrome (BS) is an arrhythmogenic ion channelopathy, which constitutes a distinct subtype of idiopathic ventricular fibrillation. It is characterized by unique electrocardiographic (ECG) manifestations, including right bundle branch block, ST-segment elevation of coved or saddle-back type, and T-wave inversion in the right precordial ECG from V1 to V3 leads, and a high incidence of sudden death from ventricular tachyarrhythmia. Early repolarization (ER) has traditionally been considered a benign entity with ECG characterized by an elevation greater than 0.1 mV of the junction between the end of the magnetic resonance angiography (QRS) complex and the beginning of the ST segment (J point) and a notching or slurring of the terminal portion of the QRS complex followed by a positive T wave. Early repolarization pattern (ERP) has been associated with vulnerability to ventricular fibrillation in independent case-controlled studies. Recently, clinical interest in ERP has been rekindled because of its similarities with BS. Here, we reported a case of a middle-aged male who presented with syncope that unmasked an ECG pattern consistent with diagnoses of both BS and ER, and discussed the variations in BS and the high-risk features associated with it.