WPW or Brugada variant

[PikaPika88]

Thanks every one to reply my post "Pacemaker & Stress test".

I've gone through the treadmill street test!  Think what number I score?  A1???  I wish to and I think the doc would give me A1+++ because I've been a very good girl. I didn't complaint any!

First, I don't know what I got is good news or bad news.  Mine ECG spit out as  following:

1st degree A-V block.
Right atrial enlargement
Left ventricular hypertrophy
Anterior myocardial infarction, age undetermined
Possibly acute inferior myocardial infarction

The doc crossed out all of them and write Bundle Branch Block + ST Elevation V1 ? Brugada variant.  

Here are my questions:

1.  Why I get 1st degree A-V block?  My pacemaker must be slack.  It should pace upper and lower chamber of the right side.  ???  Because the leads are there and the cardio said my pacemaker is working fine.  May be it worked too hard and get puffy!

2.  Good news is I didn't have wpw anymore.  Bad news is I got BBB and ? Brugada variant.  Would wpw changed into Brugada variant?  What is Brugada variant?  Especially the word "variant", what is that means?  Is a question mark at the front.  It probably not related to me, he is guesting only!  I hope.  Is Brugada variant need to take med?  Is Brugada milder than wpw or as bad as wpw?  Should I tell this to my old cardio?  Is he miss diagnosed?  Brugada variant is not good though?  Make me walk on the space ship?

Please help me to interprete those.....

[bip]

I have a st. evelation in V1 and I have a Right BBB that is nothing.....I would see a EP cause if you have brugada that is not good .I had a test done called fleciande to rule out brugada........

[PikaPika88]

No, I'm not on Flecainide or any heart med now.  Was in 2005 and stopped at the end of 2005.  Is flecainide can cause Brugada variant?  What is the different of Brugada and Brugada variant?  Thanks for your reply.

[bip]

Flrecainde is a test to show if you have brugada syndrome...... I don't know what the difference is.....

[bip]

I know brugada syndrome is a high risk of sudden cardiac arrest but mBrugada variant maybe that means normal don't know.What did thet doctor say........

[va_tony]

Go to www.brugada.org . There's a lot of info on that site.

Braguda is a genetic disorder, frequently found in Asians, involving a mutation to the SCN5A gene which encodes for the cardiac sodium channel.  This can lead to vfib and fainting (and even death). I believe variant refers to the different types of gene mutations affecting SCN5A.

"The complete syndrome is characterized by episodes of fast polymorphic VT  in patients with an electrocardiogram showing a pattern of right bundle branch block and ST segment elevation in leads V1 to V3. " (from brugada.org site)

[deedle1976]

From what I understand there are 3 types of brugada sign. Type 1 is v. rare but carries a risk of serious arrhythmias. Type 2 and 3 are much more common and thought likely to be a normal variant in most people.

"studies have shown that the prevalence of Brugada ECG pattern varies between 0.2% and 6% and that in the general population the outcome is usually benign. The major limitation of those studies, however, is the relatively short duration before follow-up."

"The presence of Brugada sign, particularly Type 2 and 3 variants, in most asymptomatic individuals, without a family history of sudden death is likely to be normal variant. Brugada sign in many individuals may also be a transient, non-specific response to different stimuli."

"In conclusion, currently available data suggest that in most asymptomatic individuals without clinical risk factors such as a family history of sudden cardiac death or South-eastern Asian ethnicity, an incidental finding of Brugada type ECG (particularly type 2 or type 3) does not warrant further diagnostic tests, these individuals can be observed clinically"

[PikaPika88]

I didn't have RBBB because the pacemaker's leads all are at the right side.  It paces it out.  Was diagnosed in 15 years old with PAT and RBBB, not now.

Isn't it the present of ST segment could be a heart attack?  I got pain in my back chest!  Not front.  I don't think he found that on the normal ECG, he probably found on the treadmill stress test.  Nothing showed on the Persantin Thallium Street Test!  I find out that I can go on the treadmill !  

The Reason for Ending Test : No chest pain.  Target heart rate reached.  Interpretation limiting ECG changes (Change in Bundle Branch Block Conformation) ?  Is that good?  He didn't said change into Heart Attack!  Would it still cause pain when it changed into BBB?

Thanks.