Localized and dynamic repolarization alternans in Ajmaline accentuated Brugada syndrome

We performed incremental atrial pacing immediately after Ajmaline infusion in an asyntomatic female patient whose basal ECG was suggestive of Brugada Syndrome. Ajmaline accentuated the BS ECG pattern. Incremental Atrial pacing induced localized and dynamic repolarization alternans and unequal diastolic intervals (TQ intervals). No ventricular rhythms were elicited (other than short-coupled, monomorphic, low-density ventricular beats.