Relation of the Brugada Phenocopy to Hyperkalemia (From the International Registry on Brugada Phenocopy)

Xu, Grace; Gottschalk, Byron H.; Anselm, Daniel D.; Benditt, David G.; Maheshwari, Ankit; Sreenivasan, Shiva; Shama, Raed Abu; Dendramis, Gregory; Barajas-Martínez, Héctor; Campal, J.M. Rubio; Aznaurov, Sam G.; Baranchuk, Adrián

doi:10.1016/j.jelectrocard.2019.01.053

Cited by 5 publications

(11 citation statements)

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“…Along with hyperkalemia, ischemia is one of the most common modulators of cardiac sodium channels causing transient ECG changes . In this small series, ischemia‐induced BrP more commonly occurred as a Type‐1 ECG pattern compared to Type‐2.…”

Section: Discussionmentioning

confidence: 67%

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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Section: Discussionmentioning

confidence: 67%

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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“…5,6 In cases of hyperkalemiainduced Brugada phenocopy, the high extracellular potassium potentially inactivates cardiac sodium channels by decreasing the resting membrane potential, thus resulting in the outward potassium current dominating. 6 This negative hyperkalemic effect causes delayed depolarization resulting in ST-segment elevation in the anteroseptal region of the ECG with the Brugada type 1 pattern predominantly. 6 This patient's Brugada phenocopy occurred with a potassium of 6.1 mmol/L, less than commonly described, but likely caused by a combination of severe hyponatremia with moderate hyperkalemia.…”

Section: Discussionmentioning

confidence: 99%

“…6 This negative hyperkalemic effect causes delayed depolarization resulting in ST-segment elevation in the anteroseptal region of the ECG with the Brugada type 1 pattern predominantly. 6 This patient's Brugada phenocopy occurred with a potassium of 6.1 mmol/L, less than commonly described, but likely caused by a combination of severe hyponatremia with moderate hyperkalemia. A transmural voltage gradient of reduced inward positively charged ions (sodium) with an accentuated outward current (potassium) resulted in the characteristic ECG pattern.…”

Section: Discussionmentioning

confidence: 99%

Brugada phenocopy secondary to hyperkalemia and hyponatremia in primary adrenal insufficiency

2022

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Introduction The Brugada phenocopy represents electrocardiogram (ECG) changes nearly identical to the Brugada syndrome but without the congenital abnormality associated with lethal arrhythmias and normalizes with treatment of the underlying etiology. This case highlights the Brugada phenocopy in the setting of moderate hyperkalemia and severe hyponatremia from adrenal insufficiency that resolves with treatment of the underlying metabolic disturbance. Case Report A 26‐year‐old man with no prior medical history presented to the emergency department with syncope, and his ECG revealed a Brugada‐like pattern. The patient was found to have significant metabolic derangements, including severe hyponatremia (94 mEq/L), moderate hyperkalemia (6.1 mEq/L), severe hypochloremia (<60 mEq/L), acute kidney injury, and rhabdomyolysis. The patient was diagnosed with primary adrenal insufficiency, and electrolyte correction led to resolution of the Brugada phenocopy. Conclusion The Brugada phenocopy on ECG can occur with severe hyponatremia and moderate hyperkalemia and quickly resolves with electrolyte correction.

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“…BrP on the other hand is described as a selection of clinical disorders that demonstrate classic BrS ECG phenotypical appearance but lack the propensity to cause ventricular tachyarrhythmia and sudden death [2,4,10]. These disorders are classified by their etiological category which include metabolic imbalance, mechanical compression, ECG modulation, myocardial or pericardial disease, ischemia or pulmonary embolism, and miscellaneous causes.…”

Section: Discussionmentioning

confidence: 99%

Brugada Phenocopy Type 1 Secondary to Synthetic Cannabinoids

Amro

Okoro

Mansoor

et al. 2020

Case Reports in Cardiology

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Brugada phenocopies (BrP) are clinical entities that have EKG tracings similar to the congenital Brugada syndrome (BrS) but without ventricular tachyarrhythmias or sudden cardiac death. BrP is caused by various factors such as metabolic disturbances (electrolyte imbalance), drugs, mechanical compression of the mediastinum, and inflammatory conditions such as myocarditis or pericarditis. We present a very rare case of a young patient who had a Brugada phenocopy Type 1 suspected to be secondary to synthetic cannabinoids.

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Relation of the Brugada Phenocopy to Hyperkalemia (From the International Registry on Brugada Phenocopy)

Cited by 5 publications

References 0 publications

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

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

Brugada phenocopy secondary to hyperkalemia and hyponatremia in primary adrenal insufficiency

Brugada Phenocopy Type 1 Secondary to Synthetic Cannabinoids

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