Summary:
Brugada pattern on EKG associated with syncope is worrisome for a diagnosis of Brugada syndrome which puts patients at high risk for sudden cardiac death and requires an ICD placement by the guidelines. The patient’s family history further makes this diagnosis more likely. However, given the absence of Bugada pattern on EKG during the second episode, and given his history of substance abuse, we elected against immediate ICD placement in this case as Brugada pattern was probably brought up by the fever and patients likely does not have Brugada syndrome. His young age is also another reason to hesitate in placing ICD unless proven to be necessary. Provocative testing for Brugada is another possibility that we will consider in follow ups.