Case Report: Brugada syndrome uncovered by delivery in a 32-year-old patient.
A case report of a 32-year-old primigravida with no prior symptoms, normal baseline ECG, and negative family history who developed ventricular fibrillation shortly after uncomplicated vaginal delivery under epidural ropivacaine and sufentanil.
Post-arrest ECG showed a spontaneous type 1 Brugada pattern in V1-V2 that normalized within two days.
Structural and coronary imaging were unremarkable; whole-exome sequencing identified no pathogenic variants.
This is off-topic for structural valve disease and outside The Valve Wire's remit.
We report a 32-year-old primigravida with no prior symptoms, normal baseline ECG, and no family history of sudden death who developed ventricular fibrillation (VF) shortly after uncomplicated vaginal delivery. She received epidural ropivacaine and sufentanil during labor. Post-resuscitation ECG demonstrated coved ST-segment elevation with T-wave inversion in V1-V2, consistent with spontaneous type 1 Brugada syndrome (BrS) pattern. Echocardiography excluded structural heart disease; coronary CT angiography excluded coronary artery disease. Laboratory investigations revealed borderline hypokalemia (3.5 mmol/L) and mild hypomagnesemia (0.75 mmol/L). Clinical whole-exome sequencing revealed no pathogenic or likely pathogenic variants in established arrhythmia-associated genes. The ECG normalized two days later. An implantable cardioverter-defibrillator was implanted. This case illustrates multifactorial unmasking of latent BrS-involving ropivacaine-mediated sodium channel blockade, postpartum autonomic instability, bradycardia, and electrolyte imbalance in a genotype-negative asymptomatic woman, highlighting the importance of recognizing concealed channelopathies in peripartum cardiac arrest.
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