Prevalence of paroxysmal atrial fibrillation in Brugada syndrome: a case series and a review of the literature

Objective The present study aimed at investigating the incidence of paroxysmal atrial fibrillation in 10 patients with spontaneous or induced type 1 electrocardiographic pattern of Brugada syndrome (three with syncopal episodes and seven asymptomatic). Both clinical entities are closely associated with changes in autonomic modulation and, particularly, with increased vagal tone. Methods Transthoracic echocardiography, exercise treadmill test and 24-h Holter recordings were performed to all patients. Results Episodes of atrial fibrillation were recorded in 2/10 patients (20%). These patients suffered from syncopal episodes, exhibited a positive electrophysiological study, and finally received an implantable cardioverter-defibrillator. Conclusions The present case series points out a high incidence of paroxysmal atrial fibrillation predominantly in symptomatic patients with type 1 electrocardiographic pattern of Brugada syndrome, indicating that the presence of atrial tachyarrhythmias may reflect an advanced stage of the disease. The prognostic significance of paroxysmal atrial fibrillation, particularly in asymptomatic patients with an electrocardiographic pattern consistent with Brugada syndrome requires further evaluation. Physicians should always be aware of Brugada syndrome in young patients with lone atrial fibrillation, especially in those with a history of syncope.