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446Soon after returning to Japan, I wrote a case report about the patient I encountered at Juntendo University Hospital as I described before that was published in 1993 in Japanese Heart Journal.2) I had searched for similar cases at related hospitals, but did not find any. This syndrome was later named “Brugada syndrome (BrS)”. One day, Dr. Osamu Yamanaka, my senior by one year, asked me “Is there any relationship between VF and sinus node dysfunction?” At that time, I had not noticed the association of the two arrhythmias. Five years later (1998), the first genetic mutation of BrS was reported in Nature.3) I was glad as our case report was cited in the report’s references.In 2003, I encountered another patient with BrS at Juntendo Shizuoka Hospital. The patient was a 62-year-old man who was referred for syncope. He had also experienced two episodes of nocturnal awakening with urinary incontinence. His ECG Figure 1　Top: Twelve-lead ECG just before ventricular fibrillation (VF) showed coved type ST elevation in leads V1-3. Middle: ECG monitoring revealed a sinus pause of 3.6 sec in the evening. Bottom: Spontaneous VF occurred after midnight and was successfully converted to sinus rhythm by external DC shock. Cited with permission form ref.7.showed a typical Brugada-type ST elevation in the right precordial leads (Figure 2, left). During his hospitalization, ECG monitoring revealed asymp-tomatic episodes of sinus pause at midnight with a maximum duration of 6.6 seconds (Figure 2, right). However, during the electrophysiologic study, the patient’s sinus node function was normal and ventricular tachyarrhythmia could not be induced by the programmed electrical stimulation. On the basis of the multiple syncopal episodes including the nocturnal awakening with urinary incontinence and the typical ECG finding for BrS, the patient received with an implantable cardioverter-defibril-lator (ICD), which successfully converted an episode of VF that occurred 2 months later (Figure 3). I remembered that the first case of BrS that I observed at Juntendo University Hospital had also suffered from sinus node dysfunction. I found several papers which revealed that a single muta-