<HTML><BODY style="word-wrap: break-word; -khtml-nbsp-mode: space; -khtml-line-break: after-white-space; "><DIV>If type I ecg is present, pharmacologic test is not indicated, the diagnosis</DIV><DIV>is made.</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV>Some investigators will go ahead and implant a defibrillator, because of the</DIV><DIV>family history</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV>Others will wait until he develops any symptoms</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV>I recommend an EPS to risk stratify. If positive then ICD implant.</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV>Ramon Brugada MD FACC</DIV><DIV>Associate Professor of Medicine</DIV><DIV>Canadian Research Chair Genetics of Arrhythmias</DIV><DIV>University of Montreal</DIV><DIV>Director Clinical Cardiovascular Genetics Center</DIV><DIV>Montreal Heart Institute</DIV><DIV>5000 Rue Belanger</DIV><DIV>Montreal, QC H1T 1C8</DIV><DIV>Canada</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV><A href="mailto:ramon@brugada.org">ramon@brugada.org</A></DIV><BR><DIV><DIV><BR class="khtml-block-placeholder"></DIV><BLOCKQUOTE type="cite"><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; min-height: 14px; "><BR></DIV> <DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Dear Sergio,</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">About a case of reanimation of sudden death in a 54-year-old patient, with no structural heart disease, with all the studies made: coronary angiography, MNR, Holter, EPS. </FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Everything appears to be normal. Monomorphic arrhythmic storm is detected at the moment the patient is admitted. The patient is provided life support and he recovers in 24 hs. ICD implantation is decided. After three months he displays three shocks by arrhythmic storm, incessant ventricular tachycardia. Mapping and focus ablation is decided, in outflow tract with mismatch. </FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">To this moment, the patient has not displayed any event. It's been three months, and in a Holter register in one of his sons, typical Brugada pattern is observed. The patient is 17 years old, asymptomatic. I cannot perform pharmacological test. What should I do next? </FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 13px/normal GB18030 Bitmap; min-height: 17px; "><FONT class="Apple-style-span" face="Arial" size="3"><SPAN class="Apple-style-span" style="font-size: 12px;"><BR></SPAN></FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Dr. Cagnolatti <<A href="mailto:drcagnolattia@hotmail.com">drcagnolattia@hotmail.com</A>></FONT></DIV><FONT class="Apple-style-span" face="Arial"><BR></FONT><DIV> <SPAN class="Apple-style-span" style="border-collapse: separate; border-spacing: 0px 0px; color: rgb(0, 0, 0); font-family: Helvetica; font-size: 12px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; text-align: auto; -khtml-text-decorations-in-effect: none; text-indent: 0px; -apple-text-size-adjust: auto; text-transform: none; 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border-spacing: 0px 0px; color: rgb(0, 0, 0); font-family: Helvetica; font-size: 12px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; text-align: auto; -khtml-text-decorations-in-effect: none; text-indent: 0px; -apple-text-size-adjust: auto; text-transform: none; orphans: 2; white-space: normal; widows: 2; word-spacing: 0px; "><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">--</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Dr.<SPAN class="Apple-converted-space"> </SPAN>Sergio<SPAN class="Apple-converted-space"> </SPAN>Dubner</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">President<SPAN class="Apple-converted-space"> </SPAN>of<SPAN class="Apple-converted-space"> </SPAN>Scientific<SPAN class="Apple-converted-space"> </SPAN>Committee</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; 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