Expert cardiologists cannot distinguish between Brugada phenocopy and Brugada syndrome electrocardiogram patterns

Abstract

Our results provide strong evidence that BrP and BrS ECG patterns are visually identical and indistinguishable. These findings support the use of systematic diagnostic criteria for differentiating BrP vs. BrS as an erroneous diagnosis may have a negative impact on patient morbidity and mortality.

Link between Brugada phenocopy and myocardial ischemia: Results from the International Registry on Brugada Phenocopy

“…We therefore recommend further investigation for risk stratification in these cases. A systematic diagnostic approach is pivotal in differentiating BrP from BrS to ensure appropriate treatment and prevent unnecessary and costly interventions . It is important to highlight that a sodium blocker challenge may be unsafe and unreliable in acute ischemic events.…”

“…The type‐2 pattern is characterized by a high take‐off R′ followed by a convex ST‐segment elevation and positive or flat T‐wave in lead V2 (Figure ). Brugada phenocopy (BrP) is a clinical condition characterized by ECG patterns identical to those found in BrS yet are elicited by various clinical conditions . Upon resolution of the underlying condition, the ECG pattern normalizes (Table ) .…”

“…The type-2 pattern is characterized by a high take-off R ′ followed by a convex Brugada phenocopy (BrP) is a clinical condition characterized by ECG patterns identical to those found in BrS yet are elicited by various clinical conditions. [2][3][4] Upon resolution of the underlying condition, the ECG pattern normalizes (Table 1). [5][6][7] Given the low diagnostic yield of genetics in "true BrS," genetic testing is not a mandatory criterion for the diagnosis of BrP (Table 1).…”

Should all individuals with suspected arrhythmias but initially nondiagnostic electrocardiogram be ordered routinely higher intercostal space ECG?

“…Therefore, the transient normalization of the ECG does not make the diagnosis with standard 12‐lead ECG possible in many cases. Moreover, beyond the Brugada phenocopies, sometimes it is difficult to diagnosis BrS with standard 12‐lead ECG when the leads V1 and V2 are placed in the standard position of the right and left fourth intercostal spaces in a patient with suspected cardiac arrhythmias in daily practice …”

Monomorphic ventricular tachycardia in Brugada syndrome: True-true but related?

“…Misclassification bias is also easily understood given both the abstract nature of the cohort construction and misdiagnosis of even trained cardiologists in accurately interpreting Brugada ECG patterns. 21 …”