A case of vasospastic angina presenting Brugada-type ECG abnormalities

An electrophysiological study and a provocative test of coronary artery spa sm was attempted in a 68-year-old man who was having syncopal attacks and c hest pain. His electrocardiogram had the characteristics of Brugada syndrom e and ventricular fibrillation (VF) was induced by programmed electrical st imulation. ST-segment elevation became exaggerated by procainamide, which c ould not prevent the induction of VF. Coronary angiography revealed no sten otic lesions, and spasm in the left coronary artery was induced by intracor onary administration of acetylcholine with similar chest pain to that exper ienced before. Under treatment with diltiazem and flecainide, which suppres sed the induction of VF, the patient experienced no recurrence of symptoms despite persistent ST-segment elevation. No previous reports have described coronary spasm associated with Brugada-type ECG abnormalities, and patient s with syncope should be evaluated carefully.