Unmasking Idiopathic Brugada ECG Pattern: Inducible Type 1 Brugada Pattern in a Young Patient and Clinical Implications

Brugada syndrome is a rare inherited channelopathy associated with an increased risk of ventricular tachycardia and ventricular fibrillation, leading to syncope and sudden cardiac death. We present a case report of a young patient with an inducible type 1 Brugada pattern on an electrocardiogram (ECG), accompanied by a comprehensive literature review. The 19-year-old patient presented with dizziness and exhibited a type 2 Brugada pattern on admission ECG, which converted to a type 1 pattern following an Ajmaline test. Based on the absence of symptoms, inducible arrhythmias, or cardiac events in the patient's history, implantable cardioverter-defibrillator insertion was deemed unnecessary. Genetic testing was recommended, and screening ECGs were advised for the patient's first-degree relatives. The discussion explores the different types of Brugada patterns, their diagnostic significance, and the controversies surrounding risk stratification and management strategies. The case underscores the importance of maintaining clinical suspicion for Brugada syndrome in young patients and tailoring treatment approaches based on individual characteristics and risk factors.

Arrhythmogenic Right Ventricular Dysplasia and Brugada Syndrome Overlap

Arrhythmogenic right ventricular dysplasia (ARVD) and Brugada syndrome( BS) are associated with an increased risk of sudden cardiac death. Although they are described as two different entities, research suggests that they are not entirely separate. This paper presents a 55 years old male who presented for syncope. Interestingly, his electrocardiogram met the diagnostic criteria for both ARVD and BS. Subsequently, an implantable cardioverter-defibrillator (ICD) was implanted before discharge due to his high risk of sudden cardiac death. This case revealed that ARVD and BS clinical features can coexist in a single patient, and therefore supports the existence of a common pathophysiological basis of both diseases. 

Type 2 Brugada Electrocardiogram Pattern Due to Supra-Therapeutic Phenytoin Level

Brugada syndrome (BS) is a hereditary cardiac disease leading to sudden cardiac death. It does not display any structural cardiac abnormalities. It was first described in 1992, as the syndrome of ‘right bundle branch block, persistent ST segment elevation, and sudden death.’ Brugada phenocopy (BP) is a relatively new term used to describe electrocardiogram (ECG) patterns that resemble BS but are due to other reversible causes such as electrolyte abnormalities, fever, cocaine or alcohol intoxication, and side effect of certain medications such as sodium channel blockers, beta blockers, antidepressants, alpha adrenergic blockers, etc. Earlier studies have shown that patients taking sodium channel blocking antiepileptic drugs (AEDs) especially phenytoin can have Brugada type 1 like ECG pattern. Previously, type 2 ECG pattern secondary to supra-therapeutic phenytoin level has not been described. We describe a case with type 2 Brugada ECG pattern due to supra-therapeutic phenytoin level; the ECG pattern completely resolved following lowering the phenytoin to a therapeutic level. These patients need special considerations in ED management, disposition, and follow-up.

A meta-analytic review of prevalence for Brugada ECG patterns and the risk for death

BACKGROUND

The prevalence of Brugada ECG pattern (BrEP) is different in different regions, and its mean prevalence over the world is unknown. The risk of people with BrEP for death remains unknown. We performed a meta-analysis to determine the prevalence of BrEP and risk ratio (RR) for death.

METHODS

Relevant studies published between July 1, 2000 and August 20, 2016, which contain prevalence and RR for all-cause death and cardiac death, were included. The prevalence and RR are analyzed using meta-analysis.

RESULTS

We finally retrieved 24 studies of the prevalence for BrEP and 5 studies of the RR for all-cause death and cardiac death. The worldwide mean prevalence of BrEP is 0.4%, with highest in Asia (0.9%) and lowest in North America (0.2%). Additionally, the mean prevalence in male is 0.9%, whereas it is 0.1% in female. The RR of BrEP for all-cause death is 0.78 (95% confidence interval 0.45-1.37), and for cardiac death it is 0.92 (95% confidence interval 0.23-3.66).

CONCLUSION

The prevalence of BrEP is about 0.4% around the world with different prevalence in region and sex. Our study shows that BrEP may not be taken as a predictor of all-cause death and cardiac death.