A case of brugada syndrome presenting with ventricular fibrillation storm and prominent early repolarization

•Transient but remarked prominent early repolarization pattern, so-called “J waves”, were found on admission for recurrent VF.•Brugada syndrome was diagnosed by the typical coved type ST elevation at higher intercostal spaces.•During follow-up, coved type ST elevation appeared intermittently in the standard ECG.•When coved type ST elevation appeared, early repolarization pattern in the left precordial leads looked to be attenuated.

A 21-year-old man developed ventricular fibrillation (VF) while drinking alcohol and was admitted to our hospital. An electrocardiogram (ECG) on admission revealed remarkably prominent slurs on the terminal part of QRS complexes in the left precordial leads and a coved type ST elevation at higher intercostal spaces. After hypothermia therapy, he underwent implantation of an implantable cardioverter-defibrillator (ICD). Standard twelve-lead follow-up ECGs revealed early repolarization pattern and an intermittent coved type ST elevation. When the coved type ST elevation appeared, the early repolarization pattern in the inferior and left precordial leads was attenuated. Prominent early repolarization pattern was the most likely trigger of the VF storm in this Brugada patient.