Dietary and emotional triggers of ventricular fibrillation in Brugada syndrome: insights from a long-term subcutaneous implantable cardioverter-defibrillator case report.

Background: Brugada syndrome (BrS) is an inherited cardiac channelopathy associated with a predisposition to malignant ventricular arrhythmias and sudden cardiac death (SCD). It demonstrates a notably higher prevalence in Asian populations and exhibits profound phenotypic heterogeneity, ranging from lifelong asymptomatic carriers to individuals whose initial presentation is sudden cardiac arrest. Early diagnosis and appropriate long-term management are critical to reduce mortality. Case Description: A 42-year-old Asian male presented with recurrent ventricular fibrillation (VF) and syncope, occurring initially during sleep after consumption of a large bubble tea. Electrocardiography (ECG) confirmed a type 1 Brugada pattern. After subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation, he remained stable until emotional stress triggered two further VF episodes, both successfully terminated by the device. Over 5 years of follow-up, he experienced no syncope or inappropriate shocks, while serial ECGs showed dynamic type 1/type 2 Brugada patterns. Conclusions: In conclusion, we report the long-term course of a young Asian male with BrS who presented with an electrical storm and a late recurrence of VF triggered by emotional stress. Both events were successfully treated by a S-ICD, followed by an event-free period of 5 years, underscoring the device's long-term efficacy and safety. Despite the high-risk initial presentation, sustained arrhythmia control was achieved, demonstrating the life-saving role of ICD therapy and reflecting the episodic yet manageable nature of this channelopathy. Dynamic ECG changes and lifestyle-related triggers emphasize the importance of continuous risk stratification and patient education.