Ischemia-induced Brugada phenocopy

Agrawal, Sahil; Stevens, Steven; Shirani, Jamshid; Garg, Jalaj; Nanda, Sudip

doi:10.1016/j.jelectrocard.2015.07.007

Cited by 10 publications

(6 citation statements)

References 9 publications

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“…Resolution of ischemia restored normal conduction and resolved the ECG pattern. Repolarization abnormalities are less likely to be attributed to this finding because flow reduction was not confined to the conus branch and would have therefore not directly impacted on the RVOT [37]. This case is similar to the one previously described by Peter and further highlights the possible association between RVOT ischemia and BrP [38].…”

Section: Discussionsupporting

confidence: 70%

Suspected Brugada Phenocopy Secondary to Coronary Slow Flow

Shim¹,

Seecheran²,

Seecheran³

et al. 2019

Case Reports in Cardiology

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Brugada syndrome (BrS) is a genetic condition that accentuates the risk of potentially lethal ventricular arrhythmias and sudden cardiac death (SCD) in a structurally normal heart. The Brugada electrocardiographic pattern may manifest separately from the syndrome—this clinical scenario has been described as Brugada phenocopy (BrP). Many etiologies of BrP have been reported, but it has not yet been reported as a result of coronary slow flow (CSF) phenomenon. This case report highlights a suspected coronary slow flow-associated Brugada type 1 electrocardiographic pattern, which subsequently normalized following the institution of guideline-directed medical therapy for acute coronary syndrome.

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Section: Discussionsupporting

confidence: 70%

Suspected Brugada Phenocopy Secondary to Coronary Slow Flow

Shim¹,

Seecheran²,

Seecheran³

et al. 2019

Case Reports in Cardiology

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“…Brugada phenocopies (BrPs) describe conditions that produce Brugada-like ECG patterns but are generated by other clinical or technical factors ( Baranchuk et al, 2012 ; Anselm et al, 2014 ; Agrawal et al, 2015 ). One such BrP occasionally occurs during acute myocardial ischemia of the RVOT ( Nakamura et al, 2017 ).…”

Section: Brugada Phenocopy During Ischemiamentioning

confidence: 99%

Calcium in Brugada Syndrome: Questions for Future Research

et al. 2018

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The Brugada syndrome (BrS) is characterized by coved-type ST-segment elevation in the right precordial leads on the electrocardiogram (ECG) and increased risk of sudden cardiac death (SCD). While it is an inheritable disease, determining the true prevalence is a challenge, since patients may report no known family history of the syndrome, present with a normal spontaneous ECG pattern at the time of examination, and test negative for all known BrS-causative genes. In fact, SCD is often the first indication that a person is affected by the syndrome. Men are more likely to be symptomatic than women. Abnormal, low-voltage, fractionated electrograms have been found in the epicardium of the right ventricular outflow tract (RVOT). Ablation of this area abolishes the abnormal electrograms and helps to prevent arrhythmic recurrences. BrS patients are more likely to experience ventricular tachycardia/fibrillation (VT/VF) during fever or during an increase in vagal tone. Isoproterenol helps to reverse the ECG BrS phenotype. In this review, we discuss roles of calcium in various conditions that are relevant to BrS, such as changes in temperature, heart rate, and vagal tone, and the effects of gender and isoproterenol on calcium handling. Studies are warranted to further investigate these mechanisms in models of BrS.

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“…10,11 When the mid RCA is occluded with-out affecting the conus branch, ischemia of the Purkinje fibers in the right ventricle (RV) may delay conduction to the RVOT causing the Brugada ECG pattern. 12 Interestingly, instances of Brugada ECG pattern have not been limited to the right precordial leads (V1-V3) in myocardial ischemia. There have been reports of the ECG pattern presenting in the inferior leads (II, III, aVF) or anterolateral precordial leads (V4-V6).…”

Section: Resultsmentioning

confidence: 99%

“…Acute occlusions or anatomical anomalies such as fistulas of the conus artery may cause temporary ischemia of the RVOT, resulting in transmural dispersion of repolarization or delay in conduction that produces the Brugada ECG pattern . When the mid RCA is occluded without affecting the conus branch, ischemia of the Purkinje fibers in the right ventricle (RV) may delay conduction to the RVOT causing the Brugada ECG pattern . Interestingly, instances of Brugada ECG pattern have not been limited to the right precordial leads (V1‐V3) in myocardial ischemia.…”

Section: Discussionmentioning

confidence: 99%

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

Gottschalk

Pérez‐Riera

et al. 2019

Pacing Clinical Electrophis

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Background Brugada phenocopies clinical entities that have indistinguishable electrocardiographic (ECG) patterns from true congenital Brugada syndrome. However, they are induced by other clinical circumstances such as myocardial ischemia. The purpose of our study was to examine the clinical features and pathogenesis of ischemia‐induced Brugada phenocopy (BrP). Methods Data from 17 cases of ischemia‐induced BrP were collected from the International Registry (http://www.brugadaphenocopy.com). Data were extracted from these publications and authors were contacted to provide further insight into each case. Results Of the patients included in this study, 71% were male. Mean age was 59 ± 11 years (range: 38–76). Type‐1 Brugada ECG pattern occurred in 15/17 (88%) of the cases, while a type‐2 Brugada ECG pattern was observed in the other 2/17 (12%). In all cases, the Brugada ECG pattern resolved upon correction of the ischemia, indicating ischemia as the inducing circumstance. No arrhythmic events have been detected acutely or during the follow‐up. Reported time to resolution ranged from 2 minutes to 5 hours. Provocative challenges using sodium channel blocking agents were performed in 7/17 cases (41%), and all failed to induce a Brugada ECG pattern (BrP Class A). The remaining 10/17 cases (59%) did not undergo provocative testing due to various clinical reasons. Conclusions Myocardial ischemia is a commonly reported etiology of BrP. Importantly, this study found no association between BrP induced by myocardial ischemia and sudden cardiac death or malignant ventricular arrhythmias.

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Ischemia-induced Brugada phenocopy

Cited by 10 publications

References 9 publications

Suspected Brugada Phenocopy Secondary to Coronary Slow Flow

Suspected Brugada Phenocopy Secondary to Coronary Slow Flow

Calcium in Brugada Syndrome: Questions for Future Research

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

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