• Ondrej Benacka, Jozef Salmas, and Robert Hatala.
• Bratisl Med J. 2022 Jan 1; 123 (11): 773-776.

AbstractWe report a case of 40‑year-old healthy patient presented with aborted sudden cardiac death. Echocardiography and coronarography were normal. ECG showed minimal non-specific changes in right precordial leads. A concealed Brugada syndrome was considered. We performed a provocative ajmaline test with Brugada‑specific lead placement in 2nd, 3rd and 4th intercostal spaces at both parasternal sides. The test has confirmed the supposed diagnose. Detailed history taking revealed that the patient underwent a calf tattoo procedure on the same day. In this case report, we describe a new mechanism in Brugada patients, possibly leading to sudden cardiac death. The skin tattoo procedure is in more than 7 % of cases accompanied with a "tattoo flu syndrome", manifesting with fever, headache and fatigue. The fever is well described as a provoking factor for malignant arrhythmias in Brugada patients. Thus, a simple and safe procedure like skin tattoo can potentially lead to death in concealed Brugada syndrome population (Fig. 7, Ref. 9). Keywords: adical gastrectomy, D2 lymph node dissection, neoadjuvant therapy.

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