Atrial fibrillation associated with Wolff-Parkinson-White syndrome in a patient with concomitant Brugada syndrome

Atrial fibrillation (AF) is most prevalent in cardiac arrhythmic disease. It may be the first presenting manifestation in certain cases, such as Brugada syndrome (BrS) and WolffParkinson-White (WPW) syndrome. BrS is an inherited cardiac arrhythmic disorder characterized electrocardiographically by coved-type ST-segment elevation in the right precordial leads (V1–V3). 1 Patients with BrS are susceptible to ventricular tachycardia (VT) and consequently to sudden cardiac death (SCD). It is reported to be more common in Asia than in Western countries, with the estimated prevalence ranging from 1:1000 to 1:10000. There are 20 genes associated with BrS, and SCN5A is the major causative one. Implantable cardioverter-defibrillator (ICD) is the most effective therapy to prevent SCD, and quinidine, isoproterenol, and catheter ablation are also recommended to reduce the incidence rate of arrhythmic events. WPW syndrome is the most common cause of preexcitation, and usually it is presented with supraventricular tachycardia and AF. Even if the WPW syndrome case is asymptomatic, it may also lead to SCD. Because both disease forms could have similar symptoms, coexistence of BrS and WPW syndrome raises question about exact pathogenesis, possible interaction, related risk stratification, and therapy. In this report, by analyzing a male case with BrS and WPW syndrome with