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

Abstract

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.

A case of anomalous aortic origin of coronary artery associated with a coved‐type electrocardiogram

“…Theoretically, any disease that affect the epicardial RVOT myocardium can manifest with a coved‐type ECG and should be designated as Brugada phenocopy (BrP). Acute ischemia of the RCA is known to produce a coved‐type ST‐segment elevation and emulate BrS 2 …”

Brugada phenocopy or congenital Brugada syndrome in a patient with spontaneous pneumopericardium and pericarditis

“…He described it as a BrP with pericarditis as an underlying cause. Recently, there have been many reports describing the etiologies of BrP such as acute pericarditis 1 , myocardial ischemia, 2 Takotsubo cardiomyopathy, 3 and pulmonary embolism 4 . Contrary to the characteristic of ECG in BrP, the ECG pattern in congenital BrS is often dynamic and sometime may be concealed which could be unmasked by fever, sodium channel blockers, or recording ECG at the higher lead positions.…”

Brugada phenocopy secondary to extensive inferior wall ischemia induced by coronary steal effect

“…We postulate that our patient presented a type‐1B BrP of ischemic origin (Anselm & Baranchuk, ). The challenge test with sodium channel blockers was rejected by the patient, due to low clinical probability of BrS and the risks of ventricular arrhythmias in this clinical context (Baranchuk et al, ; Xu et al, ).…”

“…BrP associated with ischemia is manifested mainly through type‐1 Brugada ECG pattern, predominately in men, and the coronary artery most frequently involved was the RCA (65%). However, no significant association was found between the ECG findings and the artery related to ischemia causing BrP (Xu et al, ).…”