title: Massive electrical storm at disease onset in a patient with Brugada syndrome.
abstract: BACKGROUND
  Brugada syndrome (BrS) is a genetic arrhythmogenic disease characterized by ST-segment elevations in the right precordial leads of the electrocardiogram (ECG). These ECG changes may be concealed and BrS may present with electrical storm characterized by recurrent ventricular tachycardia and fibrillation.
  
  
  METHODS
  A 49-year-old previously healthy man was admitted with electrical storm. The patient received direct current (DC) cardioversion shocks and only after intravenous lidocaine did the electrical storm slowly subside with a total of 255 DC shocks administered during the first 24 h after admission. He fully recovered and received an implantable cardioverter-defibrillator. Subsequent drug challenge with flecainide revealed type 1 BrS.
  
  
  CONCLUSIONS
  Massive electrical storm can be the first symptom of BrS and the diagnostic ECG changes may be concealed at presentation. Although hundreds of DC shocks may be required during initial treatment, full recovery can be achieved.
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
authors.forename: Jannik L
authors.initials: JL
authors.lastname: Pallisgaard
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
authors.forename: Uffe
authors.initials: U
authors.lastname: Gang
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
authors.forename: Jørgen K
authors.initials: JK
authors.lastname: Kanters
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Hansen
mesh_terms: D053840:Brugada Syndrome / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D004554:Electric Countershock; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy