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He had implanted a single-lead ICD in his 50s. 34 years after the last syncope, the ICD delivered four inappropriate shocks due to paroxysmal AF, successfully treated with pulmonary vein isolation. Ageing likely increased AF burden, despite its infrequency during follow-up. This case highlights the limitations of single-lead ICDs in AF detection and the importance of tailored management in elderly BrS patients.<\/jats:p>","DOI":"10.1136\/bcr-2025-269881","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T14:55:32Z","timestamp":1772031332000},"page":"e269881","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Inappropriate ICD shock occurred 34 years after the last syncope in a symptomatic Brugada patient: does arrhythmia risk shift from VF to AF with age in Brugada syndrome?"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3848-275X","authenticated-orcid":false,"given":"Asuka","family":"Minami-Takano","sequence":"first","affiliation":[{"name":"Department of Clinical Engineering, Faculty of Medical Science, Juntendo University, Urayasu-shi, Chiba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masataka","family":"Sumiyoshi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haruna","family":"Tabuchi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8878-9792","authenticated-orcid":false,"given":"Kikuo","family":"Isoda","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,25]]},"reference":[{"key":"2026022506551472000_19.2.e269881.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ehj.2004.01.004"},{"key":"2026022506551472000_19.2.e269881.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.10.062"},{"key":"2026022506551472000_19.2.e269881.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2016.04.004"},{"key":"2026022506551472000_19.2.e269881.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2016.05.014"},{"key":"2026022506551472000_19.2.e269881.5","doi-asserted-by":"publisher","DOI":"10.1111\/jce.12359"},{"key":"2026022506551472000_19.2.e269881.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2006.00743.x"},{"key":"2026022506551472000_19.2.e269881.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2013.10.043"},{"key":"2026022506551472000_19.2.e269881.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(02)02167-8"},{"key":"2026022506551472000_19.2.e269881.9","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.114.002705"},{"key":"2026022506551472000_19.2.e269881.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.08.029"},{"key":"2026022506551472000_19.2.e269881.11","doi-asserted-by":"crossref","unstructured":"Bisignani A , Conte G , Pannone L , et al . Long-Term Outcomes of Pulmonary Vein Isolation in Patients With Brugada Syndrome and Paroxysmal Atrial Fibrillation. 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