Brugada Phenocopy Induced by Electrolyte Disorder: A Transient Electrocardiographic Sign

Abstract

Brugada syndrome (BrS) is an important cause of sudden cardiac death (SCD) with well-defined ST-segment elevation patterns on V1 -V3 . Observation of BrS-Type-electrocardiogram (ECG) patterns in medical conditions without true BrS is called "Brugada Phenocopy" (BrP). We present a case of 61-year-old male patient with hyperkalemia, hyponatremia, and BrS-Type-1 ECG pattern in the setting of acute postrenal failure. He was denying any syncope or family history of SCD. With normalization of electrolyte levels, BrS-Type-1-ECG resolved. Electrolyte disturbances are one of the most common reasons of BrP. Being aware of BrPs and differentiating from an unmasked BrS-ECG pattern could prevent patients from lethal consequences and unnecessary treatments.

Hyponatremia induced Brugada syndrome mimicking ST segment elevation myocardial infarction

“…A Brugada pattern can be unmasked by various conditions including hypokalemia, hyperkalemia, hypercalcemia, certain drugs, and fever 1,2 . Previous case reports presented asymptomatic type‐1 Brugada pattern unmasked by hyponatremia and resolved with sodium correction 3‐5 . Here, we present another case of the Brugada syndrome being unmasked by hyponatremia.…”

Brugada syndrome, Brugada phenocopy or none?

“…Brugada phenocopies are clinical entities that present with identical ECG patterns to those of true congenital BrS but are elicited by various other clinical circumstances Baranchuk et al 2012;Hunuk et al 2016;Awad et al 2013;Ferrando-Castagnetto et al 2016;Genaro et al 2014;Rambod et al 2015. Differentiating BrP from BrS is very important for preventing misdiagnosis and unnecessary treatment.…”

“…Brugada syndrome (BrS) is a form of inherited arrhythmia syndrome characterized by a distinct ST-segment elevation in the right precordial leads with no apparent structural heart disease Brugada & Brugada, 1992;. Brugada phenocopies (BrPs) are clinical entities characterized by electrocardiogram (ECG) patterns presumed to be identical to those of true BrS but are elicited by various other underlying conditions such as myocardial ischemia, electrolyte and metabolic disorders, and others Baranchuk et al 2012;Hunuk et al 2016;Awad et al 2013;Ferrando-Castagnetto et al 2016;Genaro et al 2014;Rambod, Elhanafi, & Mukherjee, 2015;. Propafenone is a Class 1C antiarrhythmic drug which also exhibits β-adrenergic and calcium channel-blocking activities.…”

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“…10 The existence of a "Brugada Phenocopy" has been described to exist secondary to various reversible causes such as electrolyte abnormalities. 4,11 However, this seems unlikely given that the potassium never exceeded 6.5 and the typical pattern of peaked T waves, widening QRS, PR interval prolongation never appeared. A prolonged QT interval up to 610 milliseconds was noteworthy, but again this is not specific for hyperkalemia, and in fact is found more in toxic drug related malignant arrhythmias such as PRIS.…”

“…Type 1 Brugada pattern typically presents as STE with at least 2 mm down-sloping "coved-type" in the anterior precordial leads (V1-V3) followed by deep wide T wave inversions. 1,2,11,12 This pattern can occur spontaneously or after provocation with a sodium channel blocker 12 . The Brugada syndrome is linked to an increased risk of ventricular arrhythmia and sudden cardiac death.…”