Brugada phenocopy: A new electrocardiogram phenomenon

Abstract

Brugada phenocopies (BrP) are clinical entities that are etiologically distinct from true congenital Brugada syndrome. BrP are characterized by type 1 or type 2 Brugada electrocardiogram (ECG) patterns in precordial leads V1-V3. However, BrP are elicited by various underlying clinical conditions such as myocardial ischemia, pulmonary embolism, electrolyte abnormalities, or poor ECG filters. Upon resolution of the inciting underlying pathological condition, the BrP ECG subsequently normalizes. To date, reports have documented BrP in the context of singular clinical events. More recently, recurrent BrP has been demonstrated in the context of recurrent hypokalemia. This demonstrates clinical reproducibility, thereby advancing the concept of this new ECG phenomenon. The key to further understanding the pathophysiological mechanisms behind BrP requires experimental model validation in which these phenomena are reproduced under strictly controlled environmental conditions. The development of these validation models will help us determine whether BrP are transient alterations of sodium channels that are not reproducible with a sodium channel provocative test or alternatively, a malfunction of other ion channels. In this editorial, we discuss the conceptual emergence of BrP as a new ECG phenomenon, review the progress made to date and identify opportunities for further investigation. In addition, we also encourage investigators that are currently reporting on these cases to use the term BrP in order to facilitate literature searches and to help establish this emerging concept.

Ischemia-induced Brugada phenocopy

“…In conclusion the Brugada phenocopy represents an ever-expanding entity with several etiologies inducing abnormalities in either myocardial depolarization or repolarization; and culminating in an identical ECG pattern [9]. Diagnostic criteria have been established [10] and efforts to differentiate these from patients with the true congenital Brugada syndrome are prudent. …”

Bal oldali pneumothorax egy ritka EKG-megnyilvánulása: inferior STEMI és praecordialis Brugada-mintázat

“…Ezek olyan, rendszerint tranzitó rikus és akut klinikai állapotok, amelyek jellegzetes 1es típusú BrugadaEKGmintázattal járnak [10,11].…”

Brugada phenocopies are the leading differential diagnosis of Brugada syndrome

“…2 First, patients with BrP have a reversible underlying condition, such as adrenal insuffi ciency, hypokalemia or myocardial ischemia, that elicits or induces the Brugada ECG pattern. There is prompt normalisation of the ECG once this underlying condition is resolved.…”

“…3 Third, patients with BrP have a negative provocative challenge with a sodium channel blocker, while those with true congenital BrS have a positive provocative challenge. 2 Gottschalk et al recently developed a morphological classifi cation system which divides BrP into type-1 and type-2 BrP according to the manifested ECG pattern. The type-1 BrP is identical to a coved or type-1 Brugada ECG pattern and the type-2 BrP is identical to a saddleback or type-2 Brugada ECG pattern.…”

“…1 Our international registry and online educational portal provides an updated registry of BrP cases along with the diagnostic criteria. 2 Many of the conditions that the authors mention as part of their differential diagnosis for a Brugada ECG pattern are confi rmed causes of BrP, including acute pericarditis, myocardial ischemia, pulmonary embolism, hyperkalemia, hypercalcemia, hypothermia and pectus excavatum. BrP form a group of heterogeneous conditions that are perhaps the most diffi cult to differentiate from true congenital BrS due to identical ECG patterns.…”