Accelerated idioventricular rhythm unmasking the brugada electrocardiographic pattern.

It has recently been reported that a high-degree right bundle branch block (RBBB) may conceal the electrocardiographic manifestations of the Brugada ECG pattern. An 82-year-old with recent onset palpitations was seen in clinic. The resting ECG showed sinus rhythm, high-degree RBBB, and an irregular idioventricular rhythm. Some fusion beats between sinus rhythm and idioventricular rhythm occurred spontaneously depicting incomplete RBBB pattern and a clear cut elevation of the ST-segment was unveiled, giving rise to a suspicious Brugada ECG pattern. The mechanisms and implications of these findings are discussed.