Introduction: A 65 year old hypertensive female with previous history of rheumatic fever, recurrent syncope preceded by rapid regular heart beats presented complaining of palpitations, lightheadedness and prolonged pectoral angina. ECG performed on admission revealed a 150 bpm wide QRS complex tachycardia with RBBB-like morphology. Methods: Adenosine converted the AT to SR. QRS morphology in SR was identical with that during tachycardia: wide (160 ms) and fragmented, with Brugada-like pattern (i.e. coved-type ST elevation both in V1-V2 precordial and inferior leads). Blood tests ruled out acute myocardial necrosis and inflamation. Echocardiography described an aneurysm-like pouch located at the LV apex (confi rmed also by LV ventriculography and cardiac MRI), without kinetic abnormalities and normal LVEF. Epicardial coronary arteries were normal, but also lateral LV vascular subendocardial malformation was doumented. Cardiac MRI described subendocardial late enhancement with extension to the epicardium on the inferior and lateral LV walls, suggesting an ischemic etiology. Results: The patient was referred for the EP study, during which typical atrial flutter and a macroreentrant tachycardia confined to the fossa ovalis margins were induced and successfully ablated. Programmed ventricular stimulation failed to induce any ventricular significant arrhythmia. On follow-up the patient was asymptomatic and Holter monitoring failed to document the arrhythmia recurrence. Conclusions: This is probably the first case report of a Brugada-like ECG pattern associated with a LV apical aneurysm.