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A Clinical Study Starting from an Encounter with a PatientCorresponding author: Masataka SumiyoshiDepartment of Cardiology, Juntendo University Nerima Hospital3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan.TEL: +81-3-5923-3111　FAX: +81-3-5923-3217　E-mail: sumi@juntendo.ac.jp352nd Triannual Meeting of the Juntendo Medical Society “Farewell Lectures of Retiring Professors” 〔Held on Mar 31, 2021〕〔Received　Jun. 28, 2021〕〔Accepted　Jul. 13, 2021〕J-STAGE Advance published date: Oct. 11, 2021Copyright © 2021 The Juntendo Medical Society. This is an open access article distributed under the terms of Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original source is properly credited. doi: 10.14789/jmj.JMJ21-0013-R　The story of this clinical study began with a patient I encountered as a post-graduate student on night duty at Juntendo University Hospital in 1989. The patient was diagnosed as idiopathic ventricular fibrillation (IVF) with incomplete right bundle branch block and a bizarrely shaped ST segment elevation in V1-3. He had a history of sick sinus syndrome (SSS) one year earlier. Three years after that encounter, the Brugada brothers reported eight patients with IVF whose ECG findings were very similar to those of my patient, and this syndrome was later named Brugada syndrome (BrS). It is now known that there are many individuals with BrS in Japan and across Asia, and regrettably the first patient’s report was not released in Japan. With the later progress in genomic research it has become apparent that a single gene mutation could be a cause of both BrS and SSS. We have begun a clinical study of the association between BrS and SSS and have published several papers about this issue. My first patient with BrS and SSS has been doing well without syncope for over 30 years.Juntendo Medical Journal2021. 67(5), 445-449Special ReviewsAfter graduating from the graduate medical school, I encountered a very impressive patient while I was on night duty at Juntendo University Hospital in 1989. The patient was a 42-year-old man, medical nurse, who was transferred to our hospital after experiencing several episodes of syncope. One year prior to his referral, he had been diagnosed with sick sinus syndrome (SSS) and received a cardiac pacemaker at our hospital, however, he suffered from a recurrence of syncope and was brought to our hospital by ambulance. After arriving, he lost consciousness and had convulsions in the emergency room, but recovered spontaneously. The results of physical examina-tions and a chest X-ray were unremarkable. The ECG showed sinus rhythm with a slight PR prolon-gation of 0.26 sec., incomplete right bundle branch block (RBBB), and a bizarrely shaped ST segment elevation in V1-3 (Figure 1, top). However, he reported experiencing no chest pain. Two hours after his Key words: Brugada syndrome, sinus node dysfunction, pacemakerDepartment of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japanhospitalization, the patient suddenly developed polymorphic ventricular tachycardia followed by ventricular fibrillation (VF) (Figure 1, bottom). The delivery of an external DC shock successfully recov-ered sinus rhythm. Laboratory findings, echocardiographic examina-tion, and cardiac catheterization revealed no abnor-mality. We thus diagnosed as idiopathic VF (IVF). After the administration of prophylactic medical therapy, i.e., mexiletine and propranolol, VF did not recur. The ST elevation in the right precordial leads was gradually reduced after defibrillation, but it persisted.Three years later, during a study-abroad program at the Good Samaritan Hospital, Los Angeles, Cali-fornia, I found an article by the Brugada brothers that surprised me1). The Brugada brothers reported the eight patients of IVF with RBBB and persistent ST segment elevation,1) whose ECG findings were very similar to those of the above-described patient. 445Masataka SUMIYOSHI