Early Diagnosis of Brugada Syndrome with Ajmaline: Recurrent Palpitations and Recent Syncope

Abstract

Brugada syndrome is a hereditary cardiac channelopathy associated with an increased risk of ventricular arrhythmias and sudden cardiac death. Its diagnosis is based on characteristic electrocardiographic (ECG) patterns, which may require pharmacological provocation. We report the case of a 30-year-old man who presented with recurrent palpitations and a recent episode of syncope. Initial standard investigations were unremarkable. However, subtle ECG abnormalities raised clinical suspicion, prompting an ajmaline challenge that unmasked a diagnostic Brugada pattern. The patient subsequently underwent implantation of an implantable cardioverter-defibrillator (ICD) and was referred for genetic counseling and family screening. This case highlights the importance of maintaining a high index of suspicion for Brugada syndrome in patients with unexplained syncope or palpitations, even when the resting ECG appears normal. Pharmacological testing remains essential for diagnosis, and early management—including ICD implantation and familial evaluation—is crucial to reducing the risk of sudden cardiac death.