[Cardiac shotgun pellet in the interventricular septum].

Among the 3 siblings, only 1 presented pathological baseline ECG findings (type 2); he has a son with a type 1 ECG pattern. An EEF study was performed, but arrhythmia was not induced. At the time of writing, after more than 12 months of followup, no arrhythmic event has been observed and the baseline ECG is always similar to the previous one. The patient presented no chest pain during the exercise test, not even during the episode of sustained monomorphic ventricular tachycardia. Therefore, we must presume that the clinical symptoms are not related to the tachycardia. Furthermore, the patient had not previously reported the presence of palpitations and syncopal episodes. An ischemic etiology of the tachycardia was ruled out by catheterization. The malignant ventricular arrhythmia documented in our case presented during early recovery from the exercise test, immediately after maximum effort, when the sympathetic stimulus produced by exercise starts to diminish. Vagal tone is greater at this time and may have been the cause of the arrhythmia. An interesting aspect of this case is the negative EEF results. These 2 points are important, because the electrophysiological study, a diagnostic test of proven usefulness, was negative, whereas a nonroutine test for this condition triggered arrhythmia. It is worth noting that our patient SMVT, although sustained polymorphic ventricular tachycardia is much more common in this syndrome. It is also interesting that the tachycardia presented RBBB morphology, which is evidence of left ventricular origin, making this an even more curious case. In our opinion, this isolated finding does not provide a basis for recommending routine use of exercise testing for Brugada syndrome in clinical practice, although there may be a group of patients in whom recovery after strenuous exercise triggers arrhythmia, making it advisable to conduct prospective studies to determine whether the test should be routinely done among such patients.