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Adytia GJ, Sutanto H. Brugada phenocopy vs. Brugada syndrome: Delineating the differences for optimal diagnosis and management. Curr Probl Cardiol 2024; 49:102566. [PMID: 38599558 DOI: 10.1016/j.cpcardiol.2024.102566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 04/12/2024]
Abstract
Brugada syndrome (BrS) is a genetic disorder known for its characteristic electrocardiogram (ECG) patterns and increased risk of sudden cardiac death. Brugada phenocopy (BrP) presents similar ECG patterns but is distinguished by its reversible nature when the underlying conditions are resolved. This article delineates the intricacies of BrP, emphasizing its etiology, clinical presentation, diagnosis, treatment, and prognosis. The article categorizes BrP based on various underlying causes, including metabolic disturbances, myocardial infarction, and mechanical compression, among others. It also underscores the critical importance of differentiating BrP from BrS to avoid misdiagnosis and inappropriate treatment, such as unnecessary implantation of cardioverter-defibrillators. The reversible aspect of BrP underlines the necessity for an etiology-specific approach to treatment, which not only prevents cardiac death but also highlights the significance of understanding the dynamic nature of ECG patterns. Through an exploration of case studies and current research, this review advocates for increased awareness and further investigation into BrP. It aims to enhance the diagnostic accuracy and management strategies, thereby improving the prognosis for patients presenting with Brugada-like ECG patterns. The review culminates in a call for further research to close existing knowledge gaps and improve patient outcomes.
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Affiliation(s)
- Galih Januar Adytia
- Internal Medicine Residency Program, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Henry Sutanto
- Internal Medicine Residency Program, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
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2
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Gul EE, Bektasoglu G, Dogan Z. Brugada phenocopy associated with multiple psychotic drugs. J Electrocardiol 2023; 81:156-158. [PMID: 37734316 DOI: 10.1016/j.jelectrocard.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023]
Abstract
Brugada phenocopy (BrP) is a clinical condition characterized by transient ECG changes of Brugada syndrome (BrS), which can be due to various clinical conditions. We describe a case report of BrP due to psychotic drugs.
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Affiliation(s)
- Enes Elvin Gul
- Department of Cardiology, Istanbul Atlas University, Medicine Hospital, Istanbul, Turkiye.
| | - Gokhan Bektasoglu
- Department of Cardiology, Istanbul Atlas University, Medicine Hospital, Istanbul, Turkiye
| | - Zeki Dogan
- Department of Cardiology, Istanbul Atlas University, Medicine Hospital, Istanbul, Turkiye
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3
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Zhang J, Jin H. A case of Brugada phenocopy alteration induced by immune checkpoint inhibitors. J Electrocardiol 2023; 81:269-271. [PMID: 37924699 DOI: 10.1016/j.jelectrocard.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 11/06/2023]
Abstract
Immunotherapy has shown remarkable efficacy in various cancer treatments. However, enhanced T-cell immune surveillance can lead to aberrant immune responses, resulting in severe immune checkpoint inhibitor-related adverse events. This is a case report of a patient previously treated with immune checkpoint inhibitors who presented with ST-segment elevation without abnormal troponin and cardiac enzyme spectrum test results. Cardiac toxicity of immune checkpoint inhibitors mainly manifests as acute immune-mediated myocarditis. While Brugada phenocopy is commonly caused by fever, electrolyte abnormalities, tricyclic/tetracyclic antidepressants, and marijuana use, we suspect that it was induced by immune checkpoint inhibitors in the current case.
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Affiliation(s)
- Jianming Zhang
- Department of Electrocardiology, Shaoxing People's Hospital, Shaoxing, China
| | - Huayong Jin
- Department of Electrocardiology, Shaoxing People's Hospital, Shaoxing, China.
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4
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Saplaouras A, Kariki O, Mililis P, Zygouri A, Gkouziouta A, Poulos G, Adamopoulos S, Efremidis M, Nyktari E, Letsas KP. Diagnostic and therapeutic dilemmas in a patient with myocarditis, Brugada syndrome and arrhythmic syncope. J Electrocardiol 2023; 80:45-50. [PMID: 37187131 DOI: 10.1016/j.jelectrocard.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
We present a case of a previously healthy 23-year-old male who presented with chest pain, palpitations and spontaneous type 1 Brugada electrocardiographic (ECG) pattern. Positive family history for sudden cardiac death (SCD) was remarkable. Initially, clinical symptoms in combination with myocardial enzymes elevation, regional myocardial oedema with late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) and inflammatory lymphocytoid-cell infiltrates in the endomyocardial biopsy (EMB) suggested the diagnosis of a myocarditis-induced Brugada phenocopy (BrP). Under immunosuppressive therapy with methylprednisolone and azathioprine, a complete remission of both symptoms and biomarkers was accomplished. However, the Brugada pattern did not resolve. The eventually spontaneous Brugada pattern type 1 established the diagnosis of Brugada syndrome (BrS). Due to his previous history of syncope, the patient was offered an ICD that he declined. After his discharge he experienced a new episode of arrhythmic syncope. He was readmitted and received an ICD.
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Affiliation(s)
| | - Ourania Kariki
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Panagiotis Mililis
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Andromahi Zygouri
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - George Poulos
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Michael Efremidis
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Evangelia Nyktari
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
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5
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Gul EE, Gamal G, Ghazni MS, Al Nozha F. Captagon-induced Brugada phenocopy: A report of two cases. J Electrocardiol 2023; 79:21-3. [PMID: 36913784 DOI: 10.1016/j.jelectrocard.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
Brugada phenocopies (BrP) represent electrocardiogram changes identical to those of true congenital Brugada syndrome but are induced by reversible clinical conditions. Previous cases have been reported in patients following recreational drug use. This report presents two cases of type 1B BrP associated with Fenethylline abuse, a recreational drug known by its trade name, Captagon.
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6
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Elikowski W, Łazowski S, Fertała N, Zawodna-Marszałek M, Szczęśniewski P, Bolewski A, Żytkiewicz M. Brugada phenocopy in pulmonary embolism - clinicopathological case study and literature review. Pol Merkur Lekarski 2022; 50:378-383. [PMID: 36645685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Brugada syndrome (BrS) is an inherited channelopathy characterized on ECG by coved (type 1) or saddle-back (type 2) ST-segment elevation (STE) of 2 or more mm in the right precordial leads and is associated with an increased risk of malignant ventricular arrhythmias. The term Brugada phenocopy (BrPh) indicates conditions that may reversibly induce Brugada-like ECG pattern in patients without true BrS; e.g.: metabolic abnormalities, mechanical heart compression, ischemia, myocarditis/pericarditis, and pulmonary embolism (PE). Only 9 cases of BPh associated with PE have been described so far. The authors present another case of a 41-year-old-male and analyze the clinical data of all 10 subjects (7 males and 3 females). Type 1 of ECG Brugada pattern was present in 7 patients (including ours), type 2 was found in 2 persons; in 1 case ECG pattern was not defined. In 7 patients STE was prominent (5 mm or more in at least 1 lead). STE was limited to V1-V2 leads in 4 persons, extended to V3 in 3 patients and even to V4 in 3 other patients, which correlated with the significant right ventricular (RV) dilatation. Concomitant left ventricular (LV) systolic dysfunction was reported only in 1 patient, which suggested that paradoxical embolization of coronary artery was not the mechanism of BrS-like STE. Clinical course of PE was usually severe (5 individuals were treated with thrombolysis) and in 3 cases it ended with death. The autopsy was only performed on our patient. It showed diffuse (ischemic) injury of RV and LV secondary to RV overload, decreased cardiac output and severe oxygen deficiency in myocardium, which could have led to BrS pattern in ECG.
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Affiliation(s)
| | | | - Natalia Fertała
- Józef Struś Hospital, Poznań, Poland: Department of Internal Medicine
| | | | | | | | - Marcin Żytkiewicz
- Józef Struś Hospital, Poznań, Poland: Department of Internal Medicine
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7
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Rangaswamy VV, Velmurugan A, Balaji A, Balaji S. A dynamic Brugada sign due to left anterior descending coronary artery occlusion. Indian Pacing Electrophysiol J 2022; 22:291-294. [PMID: 36191744 PMCID: PMC9649340 DOI: 10.1016/j.ipej.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/26/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
Brugada phenocopies (BrP) include several conditions with a common electrocardiographic (ECG) pattern that are indistinguishable from classical Brugada syndrome (BrS). In this report, we describe two cases of acute myocardial infarction (AMI) presenting as BrP. The majority of cases of BrP in AMI have been reported due to right coronary artery (RCA) occlusion. Rarely, the left anterior descending artery (LAD) is incriminated as the cause. In both our cases of BrP, LAD was the culprit vessel.
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Affiliation(s)
| | - Aparna Velmurugan
- Department of Cardiology, Sri Ramakrishna Hospital, Coimbatore, India
| | - Akshay Balaji
- Department of Cardiology, Sri Ramakrishna Hospital, Coimbatore, India
| | - S Balaji
- Department of Cardiology, Sri Ramakrishna Hospital, Coimbatore, India
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Wang L, Zhao Y, Ma L. Case Report: Coexistent Wolff-Parkinson-White Syndrome and Brugada Phenocopy in a Patient With Pneumonia and Myocarditis. Front Cardiovasc Med 2021; 8:711364. [PMID: 34746247 PMCID: PMC8566699 DOI: 10.3389/fcvm.2021.711364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/24/2021] [Indexed: 12/01/2022] Open
Abstract
Background: In recent years, Wolff-Parkinson-White (WPW) syndrome and Brugada electrocardiogram (ECG) patterns have been reported as coexistent in the same patient. In most cases, the two waveforms appeared separately. Here, we described combinations of different waveforms on one ECG, such as the Brugada pattern with delta waves and the Brugada pattern with paroxysmal supraventricular tachycardia (PSVT). Importantly, we recorded an alternate conversion of these combined ECG waveforms, which has not previously been reported in the literature. At the same time, we confirmed that the change in the waveform was related to fever by analyzing Holter data. Case: A 48-year-old male was admitted to our hospital due to palpitations and fever. The patient had a history of a cold 3 days ago. Laboratory examinations showed an elevated neutrophil percentage (85%) and troponin I level (0.86 ng/ml). A chest computed tomography (CT) scan showed inflammation in the right lung. The diagnosis of pneumonia and myocarditis was made. ECG indicated WPW syndrome and the Brugada pattern. We recorded the dynamic changes in this combination of delta waves and Brugada waves with a Holter monitor, and we found the changes would happen when the patient's body temperature rose. The doctors thought that the patient's pulmonary infection led to fever, which caused the changes in waveform. After treatment with antibacterial therapy and supportive care, his body temperature returned to normal. The various laboratory indicators also gradually returned to normal. The doctor recommended that the patient undergo further pre-excitation bypass radiofrequency ablation treatment, but the patient refused and was discharged. Conclusion: Delta waves and Brugada ECG patterns could appear on one ECG at the same time. There were dynamic changes of QRS complex, relating to fever.
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Affiliation(s)
- Li Wang
- Department of Electrocardiogram Diagnosis, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yana Zhao
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lan Ma
- Department of Electrocardiogram Diagnosis, Second Affiliated Hospital of Anhui Medical University, Hefei, China
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Rangaswamy VV, Saggu DK, Yalagudri S, Calambur N. A case of cardiac sarcoidosis mimiking Brugada syndrome. Indian Pacing Electrophysiol J 2021; 22:47-50. [PMID: 34673214 PMCID: PMC8811276 DOI: 10.1016/j.ipej.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/30/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022] Open
Abstract
A 17-year-old boy was admitted for management of ventricular fibrillation (VF) with intermittent Brugada pattern on ECG. On evaluation, cardiac MRI revealed myocardial scar and mediastinal lymphadenopathy. 18-Fluorodeoxyglucose positron emission tomography scan showed inflammation in the heart, lungs, and lymph nodes. He was diagnosed as a case of cardiac sarcoidosis (CS) and treated with steroids. However, there was a reactivation of cardiac inflammation and the development of a second VF storm. Following catheter ablation, the patient's arrhythmia improved. This report highlights the inflammation due to CS mimicking channelopathic features.
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Kafes H, Can ID, Yaman NM, Kara M, Korkmaz A, Ozeke O, Cay S, Ozcan F, Topaloglu S, Aras D. Ajmaline-induced Brugada Phenocopy, Right Bundle Branch Block, or Both? J Innov Card Rhythm Manag 2021; 12:4682-4684. [PMID: 34595052 PMCID: PMC8476095 DOI: 10.19102/icrm.2021.120906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/18/2021] [Indexed: 11/06/2022] Open
Abstract
In equivocal or suspected cases of Brugada syndrome (BrS), ajmaline testing is frequently used in the diagnostic approach. However, the administration of sodium channel blockers can not only elicit the coved ST-segment elevation characteristic of type 1 Brugada pattern but also induce right bundle branch block (RBBB), which can preclude the electrocardiographic manifestations of BrS. We describe a case report wherein RBBB posed a diagnostic challenge during the ajmaline test for suspected BrS.
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Affiliation(s)
- Habibe Kafes
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Irem Dilara Can
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Nezaket Merve Yaman
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Meryem Kara
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Ahmet Korkmaz
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Ozcan Ozeke
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Firat Ozcan
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Serkan Topaloglu
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Dursun Aras
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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11
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Pinos J, Leiria TLL, Boccalon B, Kruse ML, De Lima GG. Brugada syndrome unmasked by left ventricle posteromedial papillary muscle ventricular tachycardia: Coincidence or consequence. J Electrocardiol 2021; 69:15-19. [PMID: 34507076 DOI: 10.1016/j.jelectrocard.2021.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/05/2021] [Accepted: 08/20/2021] [Indexed: 11/16/2022]
Abstract
A 46-year-old man presented with left ventricle posteromedial papillary muscle ventricular tachycardia, presyncope, and a type-1 Brugada pattern on the post-electrical cardioversion electrocardiogram. There was a probability of a Brugada syndrome with the expression of its disease in the left ventricle; or a left monomorphic ventricular tachycardia as a part of Brugada phenocopy; or a Brugada syndrome with left monomorphic ventricular tachycardia as an epiphenomenon. Cardiac magnetic resonance, electrophysiological study, and ajmaline test were the key diagnostic tools employed.
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Affiliation(s)
- Javier Pinos
- Cardiology Institute of Rio Grande Do Sul, University Foundation of Cardiology, Porto Alegre, RS, Brazil..
| | - Tiago Luiz Luz Leiria
- Cardiology Institute of Rio Grande Do Sul, University Foundation of Cardiology, Porto Alegre, RS, Brazil
| | - Bernardo Boccalon
- Cardiology Institute of Rio Grande Do Sul, University Foundation of Cardiology, Porto Alegre, RS, Brazil
| | - Marcelo Lapa Kruse
- Cardiology Institute of Rio Grande Do Sul, University Foundation of Cardiology, Porto Alegre, RS, Brazil
| | - Gustavo Glotz De Lima
- Cardiology Institute of Rio Grande Do Sul, University Foundation of Cardiology, Porto Alegre, RS, Brazil
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12
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Hankovszky P, Tömösvári A, Hawchar F, Farkas T, Rudas L. Tachycardia dependent early repolarisation pattern in subarachnoid haemorrhage related takotsubo syndrome. J Electrocardiol 2021; 67:52-54. [PMID: 34082151 DOI: 10.1016/j.jelectrocard.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022]
Abstract
We present a case of a patient who suffered subarachnoid haemorrhage (SAH), complicated by takotsubo syndrome, paroxysmal atrial fibrillation and ECG repolarisation abnormality, compatible with Brugada phenocopy. The early repolarisation morphology showed a paradox association with the cardiac cycle length; a relationship not yet documented in SAH. Our observation also sheds light on the genesis of the "spiked helmet" ECG sign.
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Affiliation(s)
- P Hankovszky
- University of Szeged, Deparment of Anesthesiology and Intensive Care, Semmelweis utca 6, 6720 Szeged, Hungary
| | - A Tömösvári
- University of Szeged, Deparment of Anesthesiology and Intensive Care, Semmelweis utca 6, 6720 Szeged, Hungary
| | - F Hawchar
- University of Szeged, Deparment of Anesthesiology and Intensive Care, Semmelweis utca 6, 6720 Szeged, Hungary
| | - T Farkas
- University of Szeged, Deparment of Anesthesiology and Intensive Care, Semmelweis utca 6, 6720 Szeged, Hungary
| | - L Rudas
- University of Szeged, Deparment of Anesthesiology and Intensive Care, Semmelweis utca 6, 6720 Szeged, Hungary.
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Abstract
A 34‐year‐old male patient was preparing for splenic artery embolization because of a car crash. Personal or family histories of cardiovascular diseases, sudden cardiac death, or Brugada syndrome were denied. Type 1 Brugada pattern was observed in the preoperative electrocardiogram and gradually resolved within a week. Chest blunt trauma may contribute to the transient ECG changes, and some particular considerations should be taken in this patient.
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Affiliation(s)
- Yi Li
- Department of Cardiothoracic Surgery, Wuhan Asia Heart Hospital Affiliated to Wuhan University of Science and Technology, Hubei, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yajuan Shi
- Department of Remote ECG Diagnosis Center, Qidong People's Hospital (Qidong Hospital Affiliated to Nantong University), Jiangsu, China
| | - Xiaolin Shi
- Department of Remote ECG Diagnosis Center, Qidong People's Hospital (Qidong Hospital Affiliated to Nantong University), Jiangsu, China
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14
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Casu G, Berne P, Viola G, Bandino S, Baranchuk A. Brugada phenocopy in a patient with unstable angina and three-vessel coronary artery disease. J Cardiovasc Electrophysiol 2021; 32:1187-1190. [PMID: 33586167 DOI: 10.1111/jce.14950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/29/2021] [Accepted: 02/09/2021] [Indexed: 11/27/2022]
Abstract
A 52-year-old male was admitted with unstable angina and three-vessel coronary artery disease. Electrocardiography (ECG) changes consistent with type-1 Brugada ECG pattern were noted during admission. The patient was asymptomatic for syncope and had no family history of sudden cardiac death, ICD implantation, and Brugada syndrome. After coronary by-pass graft the Brugada ECG pattern resolved, and ajmaline test did not elicit type-1 ECG pattern, confirming the suspicion of Brugada phenocopy.
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Affiliation(s)
- Gavino Casu
- Department of Cardiology, Ospedale San Francesco, Nuoro, Italy.,University of Sassari, Sassari, Italy
| | - Paola Berne
- Department of Cardiology, Ospedale San Francesco, Nuoro, Italy
| | - Graziana Viola
- Department of Cardiology, Ospedale San Francesco, Nuoro, Italy
| | - Stefano Bandino
- Department of Cardiology, Ospedale San Francesco, Nuoro, Italy
| | - Adrian Baranchuk
- Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
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15
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Khmao P, Long V, Ku N, Lim S. Brugada phenocopy or congenital Brugada syndrome in a patient with spontaneous pneumopericardium and pericarditis. J Arrhythm 2021; 37:246-248. [PMID: 33664910 PMCID: PMC7896462 DOI: 10.1002/joa3.12488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 12/08/2020] [Indexed: 11/08/2022] Open
Abstract
Brugada syndrome (BrS) is characterized by coved ST segment elevation in the right precordial lead (V1-V3). Previous reports have described type-1 or type-2 Brugada ECG pattern as a Brugada phenocopy (BrP) in various clinical condition and once the etiology is resolved, the BrP ECG pattern normalizes. We describe a case report of type-1 Brugada ECG pattern in a patient with acquired immunodeficiency syndrome (AIDS) and active pulmonary tuberculosis, which developed to spontaneous pneumopericardium and pericarditis. The coexistence of type-1 Brugada ECG pattern with spontaneous pneumopericardium and pericarditis is an extremely rare pathological condition that has not been previously described.
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Affiliation(s)
- Pichmanil Khmao
- Department of Cardiology and Geriatric MedicineKhmer‐Soviet Friendship HospitalPhnom PenhCambodia
| | - Vannak Long
- Department of Cardiology and Geriatric MedicineKhmer‐Soviet Friendship HospitalPhnom PenhCambodia
| | - No Ku
- Medical Intensive Care UnitKhmer‐Soviet Friendship HospitalPhnom PenhCambodia
| | - Sivutha Lim
- Department of Cardiology and Geriatric MedicineKhmer‐Soviet Friendship HospitalPhnom PenhCambodia
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16
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Kamakura T, Cetran L, Sacher F, Hocini M, Duchateau J. A case of anomalous aortic origin of coronary artery associated with a coved-type electrocardiogram. J Cardiovasc Electrophysiol 2021; 32:554-557. [PMID: 33421212 DOI: 10.1111/jce.14872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/04/2020] [Accepted: 01/02/2021] [Indexed: 11/29/2022]
Abstract
Brugada syndrome (BrS) is a sudden cardiac death syndrome characterized by a coved-type electrocardiogram (ECG). Different disorders, such as ischemia, can emulate a Brugada-pattern ECG (Brugada phenocopy). We report herein, the first case of surgical epicardial electrophysiological mapping in a successfully resuscitated patient with an anomalous aortic origin of the coronary artery (AAOCA) associated with a coved-type ECG. It was debatable whether the coved-type ECG and the abnormal arrhythmogenic substrate in the epicardial right ventricular outflow tract were derived from BrS or from repetitive ischemia due to AAOCA; however, the epicardial electrophysiological mapping helped in deciding the treatment strategy.
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Affiliation(s)
- Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Laura Cetran
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Frédéric Sacher
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Mélèze Hocini
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
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Carrizales-Sepúlveda EF, Vera-Pineda R, Jiménez-Castillo RA, Violante-Cumpa JR, Flores-Ramírez R, Ordaz-Farías A. The Heart in Diabetic Ketoacidosis: A Narrative Review Focusing on the Acute Cardiac Effects and Electrocardiographic Abnormalities. Am J Med Sci 2020; 361:690-701. [PMID: 33941367 DOI: 10.1016/j.amjms.2020.11.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/22/2020] [Accepted: 11/24/2020] [Indexed: 11/18/2022]
Abstract
Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus. Hyperglycemia, acidosis, and electrolyte imbalances can directly affect the heart by inducing toxicity, impairing myocardial blood flow, autonomic dysfunction, and altering activation and conduction of electrical impulses throughout the heart, increasing the risk of arrhythmias and ischemia. The electrocardiogram is useful in monitoring patients during and after an episode of DKA, as it allows the detection of arrhythmias and guides metabolic correction. Unfortunately, reports on electrocardiographic abnormalities in patients with DKA are lacking. We found two electrocardiographic patterns that are frequently reported in the literature: a pseudo-myocardial infarction and a Brugada Phenocopy. Both are associated with DKA metabolic anomalies and they resolve after treatment. Because of their clinical relevance and the challenge they represent for clinicians, we analyzed the clinical characteristics of these patients and the mechanisms involved in these electrocardiographic findings.
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Affiliation(s)
| | - Raymundo Vera-Pineda
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Raúl Alberto Jiménez-Castillo
- Internal Medicine Department, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Jorge Rafael Violante-Cumpa
- Endocrinology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Ramiro Flores-Ramírez
- Echocardiography Laboratory, Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Alejandro Ordaz-Farías
- Echocardiography Laboratory, Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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18
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Gunaseelan R, Sasikumar M, Aswin K, Dhar S, Balamurugan N, Pillai V. Brugada phenocopy induced by consumption of yellow oleander seeds - A case report. J Electrocardiol 2020; 62:107-109. [PMID: 32841866 DOI: 10.1016/j.jelectrocard.2020.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/27/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022]
Abstract
Brugada phenocopy is a brugada-like pattern in ECG seen in some diseases without an inherited channelopathy. The causes of brugada phenocopy are usually reversible. Once the reversible condition resolves, the ECG pattern disappears. There are many conditions that cause brugada phenocopy like myocardial infarction, hyperkalemia etc. Here we report a case of brugada phenocopy induced by consumption of yellow oleander seeds (T. Peruviana).
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Affiliation(s)
- R Gunaseelan
- Department of Emergency Medicine, Jawarharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
| | - M Sasikumar
- Department of Emergency Medicine, Jawarharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - K Aswin
- Department of Emergency Medicine, Jawarharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Shirshendu Dhar
- Department of Emergency Medicine, Jawarharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - N Balamurugan
- Department of Emergency Medicine, Jawarharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Vivekanandan Pillai
- Department of Emergency Medicine, Jawarharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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19
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Monterrubio-Villar J, Llinares-Moya D. Brugada Phenocopy Induced by a Lethal Methanol Intoxication. Eur J Case Rep Intern Med 2020; 7:001374. [PMID: 32133307 PMCID: PMC7050964 DOI: 10.12890/2020_001374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/23/2019] [Indexed: 11/27/2022] Open
Abstract
Brugada phenocopies (BrP) are clinical entities that present with an ECG pattern identical to either the type 1 or type 2 Brugada pattern without true congenital Brugada syndrome. This ECG pattern is associated with an identifiable condition and normalizes upon resolution or treatment of the underlying cause. We present a case of a 54-year-old man with extreme metabolic acidosis, hyperkalaemia and a Brugada type 1 ECG pattern in the setting of a suicidal methanol (MeOH) poisoning. Upon correction of these metabolic derangements with bicarbonate infusions and continuous veno-venous haemodiafiltration (CVVH), the Brugada type 1 ECG pattern normalized. Unfortunately, the patient developed signs of cerebral herniation followed by brain death and died on the first day of ICU admission.
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20
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Xu G, Gottschalk BH, Pérez-Riera A, Barbosa-Barros R, Dendramis G, Carrizo AG, Agrawal S, Bayés de Luna A, Jastrzębski M, Tomcsányi J, Baranchuk A. Link between Brugada phenocopy and myocardial ischemia: Results from the International Registry on Brugada Phenocopy. Pacing Clin Electrophysiol 2019; 42:658-662. [PMID: 30924150 DOI: 10.1111/pace.13678] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/12/2019] [Accepted: 03/04/2019] [Indexed: 11/30/2022]
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 (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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Affiliation(s)
- Grace Xu
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Byron H Gottschalk
- Department of Anesthesiology and Perioperative Medicine, Western University, London, Ontario, Canada
| | - Andrés Pérez-Riera
- Laboratory Design of Studies and Scientific Writing, ABC Faculty of Medicine, ABC Foundation, Santo André, São Paulo, Brazil
| | - Raimundo Barbosa-Barros
- Coronary Center of the Messejana's Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Gregory Dendramis
- Cardiovascular Division, Pietro Cosma Hospital, ULSS 6 Euganea, Camposampiero, Padova, Italy
| | - Aldo G Carrizo
- Cardiology Division, McMaster University, Hamilton, Ontario, Canada
| | - Sahil Agrawal
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Antonio Bayés de Luna
- Institut Català Ciències Cardiovasculars-St. Pau Hospital, and Quiron Barcelona Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Marek Jastrzębski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Cracow, Poland
| | - János Tomcsányi
- Cardiology Department, St. John of God Hospital, Budapest, Hungary
| | - Adrian Baranchuk
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
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21
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Abstract
Brugada syndrome is a genetic condition that predisposes to an increased risk of ventricular fibrillation and sudden cardiac death in a structurally normal heart. The Brugada type 1 electrocardiogram (ECG) pattern may occur independently of the actual syndrome, and this clinical phenomenon is often referred to as Brugada phenocopy. There are several other factors which have been known to induce this electrocardiographic pattern, and currently, there is a paucity of literature with respect to the pattern that is observed in patients with electrolyte disturbances, specifically hyponatremia. This case report highlights a suspected hyponatremia-induced Brugada type 1 ECG pattern, which subsequently normalized following resolution of the electrolyte derangement.
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Affiliation(s)
- Koomatie Ramsaroop
- Department of Medicine, North Central Regional Health Authority, Mt Hope, Trinidad and Tobago
| | - Rajeev Seecheran
- Department of Medicine, North Central Regional Health Authority, Mt Hope, Trinidad and Tobago
| | - Valmiki Seecheran
- Department of Medicine, North Central Regional Health Authority, Mt Hope, Trinidad and Tobago
| | - Sangeeta Persad
- Department of Medicine, North Central Regional Health Authority, Mt Hope, Trinidad and Tobago
| | - Stanley Giddings
- Department of Clinical Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago,
| | - Boris Mohammed
- Department of Medicine, North Central Regional Health Authority, Mt Hope, Trinidad and Tobago
| | - Naveen Anand Seecheran
- Department of Clinical Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago,
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Abstract
BACKGROUND Brugada phenocopies are clinical entities etiologically distinct from congenital Brugada syndrome; differentiation is crucial for management. CASE A 29 year-old male with a history of cocaine abuse, brought in by Emergency Medical Services (EMS) after he was found unresponsive and given naloxone. He was found altered but arousable with verbal stimuli. He reported snorting a white powder to get "high". He denied family history of sudden death or previous history of syncope. His ECG on presentation showed coved, ≥2 mm ST elevation with T-wave inversion in V2 consistent with Brugada EKG pattern (Figure 1). His troponin was trending up with elevated creatinine 1.6 mg/dl, liver enzymes and lactic acid, and urine toxicology was positive for cocaine. DECISION-MAKING The presentation of altered mental status is multifactorial: metabolic derangement, drugs misuse and Brugada. Finding Brugada EKG pattern should be investigated to differentiate congenital Brugada syndrome and Brugada phenocopies. This patient has no family history of sudden death and no prior history of syncope. Serial EKG showed a gradual resolution of the coved and ST elevation in V2. CONCLUSION our case demonstrates the importance of careful history taking including family history, as well as serial ECGs and treating the possible underlying etiology such as drugs abuse or electrolytes abnormality. It is also warranted to differentiate between Brugada phenocopies from congenital Brugada syndrome because therapeutic strategies are quite different with each diagnosis.
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23
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Gul EE, Haseeb S, Al Amoudi O, Baranchuk A. Brugada phenocopy associated with left ventricular aneurysm. J Electrocardiol 2018; 51:963-965. [PMID: 30497756 DOI: 10.1016/j.jelectrocard.2018.08.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 08/15/2018] [Accepted: 08/22/2018] [Indexed: 11/25/2022]
Abstract
Brugada phenocopies (BrP) are clinical entities that are characterized by ECG patterns identical to those of Brugada syndrome, but are the result of various clinical conditions. We describe the case of a 41-year-old male who exhibited BrP due to a left ventricular aneurysm in the context of chronic coronary artery disease.
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Affiliation(s)
- Enes Elvin Gul
- Division of Cardiac Electrophysiology, Madinah Cardiac Centre, Madinah, Saudi Arabia.
| | - Sohaib Haseeb
- Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - Osama Al Amoudi
- Division of Cardiac Electrophysiology, Madinah Cardiac Centre, Madinah, Saudi Arabia
| | - Adrian Baranchuk
- Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
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24
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Lippolis A, Buzzi PM, Romano IJ, De Concilio A, Gentile F. Unexpected reappearance of ST elevation in the anterior precordial leads shortly after an acute anterior myocardial infarction. J Electrocardiol 2018; 52:75-78. [PMID: 30476645 DOI: 10.1016/j.jelectrocard.2018.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 10/27/2018] [Accepted: 11/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Antonio Lippolis
- Cardiology Department, ASST Nord Milano, Ospedale E. Bassini, Cinisello Balsamo, Milano, Italy.
| | - Paola Maria Buzzi
- Cardiology Department, ASST Nord Milano, Ospedale E. Bassini, Cinisello Balsamo, Milano, Italy
| | - Ilaria Jane Romano
- Cardiology Department, ASST Nord Milano, Ospedale E. Bassini, Cinisello Balsamo, Milano, Italy
| | - Annalisa De Concilio
- Cardiology Department, ASST Nord Milano, Ospedale E. Bassini, Cinisello Balsamo, Milano, Italy
| | - Francesco Gentile
- Cardiology Department, ASST Nord Milano, Ospedale E. Bassini, Cinisello Balsamo, Milano, Italy
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25
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Yu M, Zhang Q, Huang X, Zhao X. Type 1 Brugada phenocopy in a patient with acute pericarditis. J Electrocardiol 2018; 51:1121-1123. [PMID: 30497742 DOI: 10.1016/j.jelectrocard.2018.10.087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/28/2018] [Accepted: 10/07/2018] [Indexed: 10/28/2022]
Abstract
We herein describe a case of an acute pericarditis, in which type 1 Brugada phenocopy (BrP) was documented. The patient was referred to our hospital due to severe chest pain. The twelve-lead electrocardiogram (ECG) on admission showed type 1 Brugada ECG pattern (coved-type) in the precordial leads. Echocardiography only showed mild pericardial effusion. However, his ST segment elevation returned to normal and chest discomfort disappeared 3 weeks later. Our report addresses the possibility that the coved-type ST-segment elevation cannot be a sensitive finding for Brugada syndrome (BrS). Detailed tests are anyway needed to make appropriate diagnostic and therapeutic decisions.
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Affiliation(s)
- Manli Yu
- Department of Cardiovasology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qin Zhang
- Department of Cardiovasology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xinmiao Huang
- Department of Cardiovasology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xianxian Zhao
- Department of Cardiovasology, Changhai Hospital, Second Military Medical University, Shanghai, China.
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26
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Barcos JC, Tello Santacruz IA, Monié CC, Fernández Recalde ML, Humphreys JD. Brugada phenocopy induced by severe pneumothorax. J Electrocardiol 2017; 51:343-345. [PMID: 29242054 DOI: 10.1016/j.jelectrocard.2017.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Indexed: 10/18/2022]
Abstract
A Brugada phenocopy has been defined as a clinical situation that presents with an abnormal electrocardiogram identical to any of the electrocardiographic patterns found in Brugada syndrome in the absence of the characteristic congenital genetic abnormalities. The first confirmed case of type 1 Brugada phenocopy associated with severe left pneumothorax is presented. A provocative test with ajmaline, which proved to be negative, was performed to confirm the diagnosis. The presence of ST-segment elevation in the context of pneumothorax is most infrequent.
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Affiliation(s)
- Javier C Barcos
- Department of Cardiology, Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Iván A Tello Santacruz
- Department of Cardiology, Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - César Cáceres Monié
- Department of Cardiology, Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - María L Fernández Recalde
- Department of Cardiology, Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan D Humphreys
- Department of Cardiology, Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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27
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Abstract
Two patients without cardiac history demonstrated type 1 Brugada pattern during hospitalization for diabetic ketoacidosis (DKA). Both patients had normalization of their ECGs after treatment of marked electrolyte abnormalities and metabolic acidosis. In this report, we describe two cases of Brugada phenocopy associated with DKA in children.
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Affiliation(s)
- Ryan E Alanzalon
- Division of Pediatric Cardiology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 631, Rochester, NY, USA
| | - Jonathan R Burris
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 777-R, Rochester, NY, USA
| | - Jeffrey M Vinocur
- Division of Pediatric Cardiology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 631, Rochester, NY, USA.
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28
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Pérez-Riera AR, Barbosa Barros R, Daminello-Raimundo R, Resende Barbosa MPC, de Abreu LC. Brugada phenocopy caused by a compressive mediastinal tumor. Ann Noninvasive Electrocardiol 2017; 23:e12509. [PMID: 29034526 DOI: 10.1111/anec.12509] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 09/17/2017] [Indexed: 11/28/2022] Open
Abstract
Recently, it has been shown that even experts in electrocardiography cannot differentiate the electrocardiographic pattern of genuine Brugada syndrome (BrS) from Brugada phenocopy (BrP). For this reason, this differentiation depends on the presence of established criteria both for BrS and BrP. In this manuscript, we present a patient with type 1 Brugada electrocardiographic pattern caused by expansive anterior mediastinal non-Hodgkin's lymphoma (NHL) with mechanical compression on the right ventricular outflow tract. The electrocardiographic pattern disappeared rapidly after antineoplastic measures.
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Affiliation(s)
- Andrés R Pérez-Riera
- Design of Studies and Scientific Writing Laboratory of the ABC School of Medicine, Santo André, Brazil
| | - Raimundo Barbosa Barros
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil
| | | | | | - Luiz C de Abreu
- Design of Studies and Scientific Writing Laboratory of the ABC School of Medicine, Santo André, Brazil
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29
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Abstract
BACKGROUND Metallic phosphides (of aluminum and phosphide) and yellow phosphorus are commonly used rodenticide compounds in developing countries. Toxicity of yellow phosphorus mostly pertains to the liver, kidney, heart, pancreas and the brain. Cardiotoxicity with associated Brugada ECG pattern has been reported only in poisoning with metallic phosphides. METHODS AND RESULTS Brugada phenocopy and hepatic dysfunction were observed in a 29-year-old male following yellow phosphorus consumption. He had both type 1 (day1) and type 2 (day2) Brugada patterns in the electrocardiogram, which resolved spontaneously by the third day without hemodynamic compromise. CONCLUSION Toxins such as aluminum and zinc phosphide have been reported to induce Brugada ECG patterns due to the generation of phosphine. We report the first case of yellow phosphorus-related Brugada phenocopy, without hemodynamic compromise or malignant arrhythmia.
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Affiliation(s)
- Mayakrishnan Dharanipradab
- Department of General Medicine, Indira Gandhi Medical College & Research Institute, Kathirkamam, Pondicherry 605009, India
| | - Stalin Viswanathan
- Department of General Medicine, Indira Gandhi Medical College & Research Institute, Kathirkamam, Pondicherry 605009, India.
| | - Gokula Raman Kumar
- Department of General Medicine, Indira Gandhi Medical College & Research Institute, Kathirkamam, Pondicherry 605009, India
| | - Vijayalatchumy Krishnamurthy
- Department of General Medicine, Indira Gandhi Medical College & Research Institute, Kathirkamam, Pondicherry 605009, India
| | - Daphene Divya Stanley
- Department of General Medicine, Indira Gandhi Medical College & Research Institute, Kathirkamam, Pondicherry 605009, India
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30
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Abstract
CASE PRESENTATION A 68-year-old female presented with non-ST-segment elevation myocardial infarction, and urgency coronary angiography was performed. The procedure was complicated with right coronary artery dissection leading to type-1 Brugada ECG pattern. DISCUSSION Brugada phenocopies (BrP) are clinical entities that present with electrocardiograms identical to those found in Brugada Syndrome (BrS) but are the result of different medical conditions. This report provides evidence that atypical causes of myocardial ischemia may induce BrP. Appropriate electrocardiogram and clinical differentiation of Brugada phenocopy from true Brugada syndrome may prevent unnecessary treatments. Although patients with true high-risk BrS are candidates for ICD therapy, the natural history of BrP remains unknown and seems to be more benign, depending on the severity of the underlying condition.
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Affiliation(s)
- Aldo G Carrizo
- Cardiology Division, McMaster University, Hamilton, Ontario, Canada.
| | - Anahi Goransky
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Adrian Baranchuk
- Cardiology Division, Queen's University, Kingston, Ontario, Canada
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31
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Siniorakis E, Arvanitakis S, Tzevelekos P, Panta S, Balanis A, Aivalioti F, Limberi S. Pectus excavatum: Right ventricular compromise with orthostatic syndrome and Brugada phenocopy. J Saudi Heart Assoc 2017; 29:223-226. [PMID: 28652678 PMCID: PMC5475344 DOI: 10.1016/j.jsha.2017.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 12/06/2016] [Accepted: 01/23/2017] [Indexed: 11/30/2022] Open
Abstract
Pectus excavatum (PEXT) consists of an overgrowth of the chondral region with posterior displacement of the inferior part of the sternum, resulting in a concave chest deformity. Characteristic clinical and imaging findings may occur, depending on the compression that right cardiac chambers suffer, when squeezed between the sternum and the column vertebrae.
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Affiliation(s)
| | | | | | - Stamatia Panta
- Cardiology Department, Sotiria Chest Diseases Hospital, Athens, Greece
| | - Apostolos Balanis
- Cardiology Department, Sotiria Chest Diseases Hospital, Athens, Greece
| | - Fotini Aivalioti
- Cardiology Department, Sotiria Chest Diseases Hospital, Athens, Greece
| | - Sotiria Limberi
- Cardiology Department, Sotiria Chest Diseases Hospital, Athens, Greece
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32
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Kocabas U, Hasdemir C, Kaya E, Turkoglu C, Baranchuk A. Brugada syndrome, Brugada phenocopy or none? Ann Noninvasive Electrocardiol 2017; 22. [PMID: 28608483 DOI: 10.1111/anec.12470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/08/2017] [Indexed: 11/29/2022] Open
Abstract
Brugada syndrome is a form of inherited arrhythmia syndrome characterized by a distinct ST-segment elevation in the right precordial leads. Brugada phenocopies are clinical entities that present with an electrocardiographic pattern identical to Brugada syndrome and may obey to various clinical conditions. We present a case of a suicidal attempt using a high dose of propafenone causing a Brugada-type electrocardiographic pattern. Is this a Brugada syndrome case, a Brugada phenocopy or something else?
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Affiliation(s)
- Umut Kocabas
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Esra Kaya
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Cuneyt Turkoglu
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Adrian Baranchuk
- Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
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33
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Pérez-Riera AR, Baranchuk A, Zhang L, Barbosa-Barros R, de Abreu LC, Brugada P. Myotonic dystrophy and Brugada syndrome: A common pathophysiologic pathway? J Electrocardiol 2017; 50:513-517. [PMID: 28389016 DOI: 10.1016/j.jelectrocard.2017.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Indexed: 11/18/2022]
Abstract
Type 1 myotonic dystrophy (DM1) is a hereditary neuromuscular disease affecting multiple organs in human adults. Here we report a 42-year-old man diagnosed with DM1. Having a history of progressive muscular weakness and gradual loss of visual acuity, he was referred to us by his ophthalmologist for risk assessment of undergoing cataract surgery. Cardiology workup revealed type 1 Brugada ECG pattern, positive late potentials and inducible ventricular fibrillation in an electrophysiology study. Literature review revealed that those ECG changes may be observed in DM1, suggesting that DM1 and Brugada syndrome may share a common pathophysiologic pathway.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Design of Studies and Scientific Writing Laboratory at the ABC School of Medicine, Santo André, São Paulo, Brazil.
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Li Zhang
- Lankenau Medical Center and Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE, Brazil
| | - Luiz Carlos de Abreu
- Design of Studies and Scientific Writing Laboratory at the ABC School of Medicine, Santo André, São Paulo, Brazil
| | - Pedro Brugada
- Department of Cardiology, Heart Rhythm Management Center, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Abstract
Brugada phenocopies are clinical entities that are different from the true Brugada syndrome which is a channelopathy. Brugada phenocopy has reversible underlying conditions and, if underlying conditions resolve, the ECG pattern disappears. In this paper the author reviews and illustrates the known Brugada phenocopies. The most important etiologic categories of Brugada phenocopy include metabolic abnormalities (most commonly hyperkalemia), myocardial infarction, pulmonary embolism (massive), right ventricular mechanical compression, and others. The most important clinical issue is the different treatment of the Brugada syndrome and phenocopies in order to prevent cardiac death. In Brugada syndrome the implantable cardioverter defibrillator is the only effective treatment, while in Brugada phenocopies early, etiology-specific treatment can prevent cardiac death.
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Affiliation(s)
- János Tomcsányi
- Kardiológia, Budai Irgalmasrendi Kórház Budapest, Árpád fejedelem u. 7. II. em., 1023
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35
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Gottschalk BH, Anselm DD, Baranchuk A. Ischemic Brugada phenocopy during ablation of ventricular tachycardia. J Arrhythm 2016; 32:156. [PMID: 27092200 PMCID: PMC4823580 DOI: 10.1016/j.joa.2015.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/06/2015] [Indexed: 01/08/2023] Open
Affiliation(s)
| | | | - Adrian Baranchuk
- Division of Cardiology, Queen’s University, Kingston General Hospital, Kingston, Ontario, Canada
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Hunuk A, Hunuk B, Kusken O, Onur OE. Brugada Phenocopy Induced by Electrolyte Disorder: A Transient Electrocardiographic Sign. Ann Noninvasive Electrocardiol 2016; 21:429-32. [PMID: 26910573 DOI: 10.1111/anec.12350] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 01/07/2016] [Accepted: 01/10/2016] [Indexed: 11/26/2022] Open
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.
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Affiliation(s)
- Aysel Hunuk
- Department of Emergency Medicine, Fatih Sultan Mehmet Research and Education Hospital, Istanbul, Turkey
| | - Burak Hunuk
- Clinic of Cardiology, Maltepe C.I.K. State Hospital, Istanbul, Turkey
| | - Ozlem Kusken
- Department of Emergency Medicine, Fatih Sultan Mehmet Research and Education Hospital, Istanbul, Turkey
| | - Ozge Ecmel Onur
- Department of Emergency Medicine, Fatih Sultan Mehmet Research and Education Hospital, Istanbul, Turkey
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37
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Abstract
To date Brugada syndrome (BrS) is considered a primary electrical heart disease and the diagnosis is based on precise clinical and electrocardiographic features. Many other diseases and conditions can lead to a Brugada-like ECG pattern but the vast majority of patients with BrS possess a structurally normal heart, which is consistent with the notion that this is a primary electrical heart disease. Presently, the terminology used in the literature to describe Brugada type 1 ECG pattern induced in patients without BrS is diverse and variable. Brugada phenocopies (BrP) are clinical entities that present with identical ECG patterns to those of true BrS but are elicited by various other clinical circumstances. They form a group of heterogeneous conditions that are perhaps the most difficult to differentiate from true congenital BrS due to identical ECG patterns and recently has been proposed an updated classification of conditions that may induce BrP and many criteria useful to differentiate BrP from BrS. A systematic diagnostic approach is crucial to avoid diagnostic errors that involve expenditure of time and resources, but above all it is useful to avoid to send patients without a real BrS to inopportune diagnostic and therapeutic paths that are sometimes burdened by considerable risks.
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Affiliation(s)
- Gregory Dendramis
- Cardiovascular Division, Department of Internal Medicine and Cardiovascular Diseases, University Hospital "Paolo Giaccone", Palermo, Italy.
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38
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Gottschalk BH, Garcia-Niebla J, Anselm DD, Jaidka A, De Luna AB, Baranchuk A. New methodologies for measuring Brugada ECG patterns cannot differentiate the ECG pattern of Brugada syndrome from Brugada phenocopy. J Electrocardiol 2015; 49:187-91. [PMID: 26851992 DOI: 10.1016/j.jelectrocard.2015.12.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Brugada phenocopies (BrP) are clinical entities characterized by ECG patterns that are identical to true Brugada syndrome (BrS), but are elicited by various clinical circumstances. A recent study demonstrated that the patterns of BrP and BrS are indistinguishable under the naked eye, thereby validating the concept that the patterns are identical. OBJECTIVE The aim of our study was to determine whether recently developed ECG criteria would allow for discrimination between type-2 BrS ECG pattern and type-2 BrP ECG pattern. METHODS Ten ECGs from confirmed BrS (aborted sudden death, transformation into type 1 upon sodium channel blocking test and/or ventricular arrhythmias, positive genetics) cases and 9 ECGs from confirmed BrP were included in the study. Surface 12-lead ECGs were scanned, saved in JPEG format for blind measurement of two values: (i) β-angle; and (ii) the base of the triangle. Cut-off values of ≥58° for the β-angle and ≥4mm for the base of the triangle were used to determine the BrS ECG pattern. RESULTS Mean values for the β-angle in leads V1 and V2 were 66.7±25.5 and 55.4±28.1 for BrS and 54.1±26.5 and 43.1±16.1 for BrP respectively (p=NS). Mean values for the base of the triangle in V1 and V2 were 7.5±3.9 and 5.7±3.9 for BrS and 5.6±3.2 and 4.7±2.7 for BrP respectively (p=NS). The β-angle had a sensitivity of 60%, specificity of 78% (LR+ 2.7, LR- 0.5). The base of the triangle had a sensitivity of 80%, specificity of 40% (LR+ 1.4, LR- 0.5). CONCLUSIONS New ECG criteria presented relatively low sensitivity and specificity, positive and negative predictive values to discriminate between BrS and BrP ECG patterns, providing further evidence that the two patterns are identical.
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Affiliation(s)
- Byron H Gottschalk
- Department of Cardiology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Javier Garcia-Niebla
- Servicios Sanitarios del Área de Salud de El Hierro, Valle del Golfo Health Center, Canary Island, Spain
| | - Daniel D Anselm
- Libin Cardiovascular Institute of Alberta, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Atul Jaidka
- Department of Cardiology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Antoni Bayés De Luna
- Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa CreuiSant Pau, Barcelona, Spain
| | - Adrian Baranchuk
- Department of Cardiology, Kingston General Hospital, Queen's University, Kingston, ON, Canada.
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39
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Gottschalk BH, Anselm DD, Brugada J, Brugada P, Wilde AA, Chiale PA, Pérez-Riera AR, Elizari MV, De Luna AB, Krahn AD, Tan HL, Postema PG, Baranchuk A. Expert cardiologists cannot distinguish between Brugada phenocopy and Brugada syndrome electrocardiogram patterns. Europace 2015; 18:1095-100. [PMID: 26498159 DOI: 10.1093/europace/euv278] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 07/21/2015] [Indexed: 12/13/2022] Open
Abstract
AIMS Brugada phenocopies (BrPs) are electrocardiogram (ECG) patterns that are identical to true Brugada syndrome (BrS) but are induced by various clinical conditions. The concept that both ECG patterns are visually identical has not been formally demonstrated. The aim of our study was to determine if experts on BrS were able to accurately distinguish between the BrS and BrP ECG patterns. METHODS AND RESULTS Six ECGs from confirmed cases of BrS and six ECGs from previously published cases of BrP were included in the study. Surface 12-lead ECGs were scanned, saved in JPEG format, and sent to 10 international experts on BrS for evaluation (no clinical history provided). Evaluators were asked to label each case as a Brugada ECG pattern or non-Brugada ECG pattern by visual interpretation alone. The overall accuracy was 53 ± 33% for all cases. Within the BrS cases, the mean accuracy was 63 ± 34% and within the BrP cases, the mean accuracy was 43 ± 33%. Intra-observer repeatability was moderate (κ = 0.56) and inter-observer agreement was fair (κ = 0.36) while evaluator accuracy vs. the true diagnosis was only marginally better than chance (κ = 0.05). Similarly, diagnostic operating characteristics were poor (sensitivity 62%, specificity 43%, +LR 1.1, -LR 0.9). CONCLUSION 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.
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Affiliation(s)
- Byron H Gottschalk
- Department of Cardiology, Cardiac Electrophysiology and Pacing, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada K7L 2V7
| | - Daniel D Anselm
- Department of Cardiology, Cardiac Electrophysiology and Pacing, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada K7L 2V7
| | - Josep Brugada
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pedro Brugada
- Heart Rhythm Management Center, UZ Brussels-VUB, Brussels, Belgium
| | - Arthur A Wilde
- Heart Centre AMC, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
| | - Pablo A Chiale
- Division of Cardiology, Hospital Ramos Mejia, Buenos Aires, Argentina
| | - Andres R Pérez-Riera
- Cardiology Discipline, ABC Medical Faculty, ABC Foundation, Santo André, São Paulo, Brazil
| | - Marcelo V Elizari
- Division of Cardiology, Hospital Ramos Mejia, Buenos Aires, Argentina
| | - Antoni Bayés De Luna
- Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa CreuiSant Pau, Barcelona, Spain
| | - Andrew D Krahn
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Hanno L Tan
- Heart Centre AMC, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Pieter G Postema
- Heart Centre AMC, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Adrian Baranchuk
- Department of Cardiology, Cardiac Electrophysiology and Pacing, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada K7L 2V7
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40
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Anselm DD, Evans JM, Baranchuk A. Brugada phenocopy: A new electrocardiogram phenomenon. World J Cardiol 2014; 6:81-86. [PMID: 24669289 PMCID: PMC3964189 DOI: 10.4330/wjc.v6.i3.81] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 12/24/2013] [Accepted: 01/16/2014] [Indexed: 02/06/2023] Open
Abstract
Brugada phenocopies (BrP) are clinical entities that are etiologically distinct from true congenital Brugada syndrome. BrP are characterized by type 1 or type 2 Brugada electrocardiogram (ECG) patterns in precordial leads V1-V3. However, BrP are elicited by various underlying clinical conditions such as myocardial ischemia, pulmonary embolism, electrolyte abnormalities, or poor ECG filters. Upon resolution of the inciting underlying pathological condition, the BrP ECG subsequently normalizes. To date, reports have documented BrP in the context of singular clinical events. More recently, recurrent BrP has been demonstrated in the context of recurrent hypokalemia. This demonstrates clinical reproducibility, thereby advancing the concept of this new ECG phenomenon. The key to further understanding the pathophysiological mechanisms behind BrP requires experimental model validation in which these phenomena are reproduced under strictly controlled environmental conditions. The development of these validation models will help us determine whether BrP are transient alterations of sodium channels that are not reproducible with a sodium channel provocative test or alternatively, a malfunction of other ion channels. In this editorial, we discuss the conceptual emergence of BrP as a new ECG phenomenon, review the progress made to date and identify opportunities for further investigation. In addition, we also encourage investigators that are currently reporting on these cases to use the term BrP in order to facilitate literature searches and to help establish this emerging concept.
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41
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Peters S. Brugada phenocopy or Brugada ECG pattern in patients characterized by early repolarization pattern and additional arrhythmogenic right ventricular cardiomyopathy. Int J Cardiol 2014; 172:278. [PMID: 24447731 DOI: 10.1016/j.ijcard.2013.12.241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 12/30/2013] [Indexed: 11/22/2022]
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Genaro NR, Anselm DD, Cervino N, Estevez AO, Perona C, Villamil AM, Kervorkian R, Baranchuk A. Brugada phenocopy clinical reproducibility demonstrated by recurrent hypokalemia. Ann Noninvasive Electrocardiol 2013; 19:387-90. [PMID: 24147860 DOI: 10.1111/anec.12101] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Brugada phenocopies (BrP) are clinical entities that are etiologically distinct from true congenital Brugada syndrome (BrS). BrP are characterized by type 1 or type 2 Brugada electrocardiogram (ECG) patterns in precordial leads V1 -V3 ; however, BrP are elicited by various underlying clinical conditions such as electrolyte disturbances, myocardial ischemia, or poor ECG filters. In this report, we describe the first case of clinically reproducible BrP which is important to the conceptual evolution of BrP.
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Affiliation(s)
- Natalia R Genaro
- Hospital General de Agudos Donación Francisco Santojanni, Buenos Aires, Argentina
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43
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Awad SF, Barbosa‐Barros R, de Sousa Belem L, Cavalcante CP, Riera ARP, Garcia‐Niebla J, Anselm DD, Baranchuk A. Brugada phenocopy in a patient with pectus excavatum: systematic review of the ECG manifestations associated with pectus excavatum. Ann Noninvasive Electrocardiol 2013; 18:415-20. [PMID: 24047484 PMCID: PMC6932653 DOI: 10.1111/anec.12082] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Brugada phenocopies (BrP) have emerged as new clinical entities that are etiologically distinct from true Brugada syndrome (BrS). BrP are characterized by an ECG pattern that is phenotypically identical to true BrS (type 1 or type 2); however, BrP are caused by various other factors such as mechanical mediastinal compression, myocardial ischemia, pericarditis, myocarditis, pulmonary embolism, and metabolic disturbances. We report a case of an electrocardiographic BrP in a patient with pectus excavatum deformity in the absence of true BrS using currently defined BrP diagnostic criteria. A systematic review of ECG manifestations associated with pectus excavatum is also discussed.
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Affiliation(s)
- Sara F.M. Awad
- Department of Cardiology, Electrophysiology and PacingQueen's University, Kingston General HospitalKingstonOntarioCanada
| | | | | | | | | | | | - Daniel D. Anselm
- Department of Cardiology, Electrophysiology and PacingQueen's University, Kingston General HospitalKingstonOntarioCanada
| | - Adrian Baranchuk
- Department of Cardiology, Electrophysiology and PacingQueen's University, Kingston General HospitalKingstonOntarioCanada
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