101
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Dharanipradab M, Viswanathan S, Kumar GR, Krishnamurthy V, Stanley DD. Yellow phosphorus-induced Brugada phenocopy. J Electrocardiol 2017; 51:129-131. [PMID: 28987296 DOI: 10.1016/j.jelectrocard.2017.08.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Indexed: 11/16/2022]
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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102
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Arı ME, Ekici F. Brugada-Phenocopy Induced by Propafenone Overdose and Successful Treatment: A Case Report. Balkan Med J 2017; 34:473-475. [PMID: 28381391 PMCID: PMC5635637 DOI: 10.4274/balkanmedj.2016.1185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Brugada syndrome is an inherited arrhythmogenic disease that may cause sudden cardiac death due to ventricular fibrillation in young adults. Brugada syndrome caused by propafenone intoxication has been noted rarely in the literature. We report a rare case, Brugada phenocopy due to propafenone intoxication and its treatment. Case Report: A 15-year-old girl having a seizure was brought to the emergency room. She took 1.5 g propafenone (Rythmol, Abbott, Chicago, IL, USA) for suicidal intention. She had metabolic acidosis. Long QRS interval and ST elevation in leads V1 through V3 were seen on electrocardiography. After bicarbonate infusion for 4 hours, haemodynamic and neurologic findings were recovered, and all electrocardiography abnormalities disappeared. The Brugada-like electrocardiography pattern was not recognized in her surface and 24-hour Holter electrocardiography at follow-up. Ajmaline challenge test was negative 2 weeks later. Conclusion: Absence of symptoms and documented ventricular tachycardia, negative challenge test, and a negative family history demonstrated that the Brugada phenocopy was a transient finding in this case and related to propafenone intoxication.
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Affiliation(s)
- Mehmet Emre Arı
- Department of Pediatric Cardiology, Ankara Children's Hematology and Oncology Training and Research Hospital, Ankara, Turkey
| | - Filiz Ekici
- Department of Pediatric Cardiology, Ankara Children's Hematology and Oncology Training and Research Hospital, Ankara, Turkey
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103
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Peters CH, Yu A, Zhu W, Silva JR, Ruben PC. Depolarization of the conductance-voltage relationship in the NaV1.5 mutant, E1784K, is due to altered fast inactivation. PLoS One 2017; 12:e0184605. [PMID: 28898267 PMCID: PMC5595308 DOI: 10.1371/journal.pone.0184605] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/28/2017] [Indexed: 12/19/2022] Open
Abstract
E1784K is the most common mixed long QT syndrome/Brugada syndrome mutant in the cardiac voltage-gated sodium channel NaV1.5. E1784K shifts the midpoint of the channel conductance-voltage relationship to more depolarized membrane potentials and accelerates the rate of channel fast inactivation. The depolarizing shift in the midpoint of the conductance curve in E1784K is exacerbated by low extracellular pH. We tested whether the E1784K mutant shifts the channel conductance curve to more depolarized membrane potentials by affecting the channel voltage-sensors. We measured ionic currents and gating currents at pH 7.4 and pH 6.0 in Xenopus laevis oocytes. Contrary to our expectation, the movement of gating charges is shifted to more hyperpolarized membrane potentials by E1784K. Voltage-clamp fluorimetry experiments show that this gating charge shift is due to the movement of the DIVS4 voltage-sensor being shifted to more hyperpolarized membrane potentials. Using a model and experiments on fast inactivation-deficient channels, we show that changes to the rate and voltage-dependence of fast inactivation are sufficient to shift the conductance curve in E1784K. Our results localize the effects of E1784K to DIVS4, and provide novel insight into the role of the DIV-VSD in regulating the voltage-dependencies of activation and fast inactivation.
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Affiliation(s)
- Colin H. Peters
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alec Yu
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Wandi Zhu
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Jonathan R. Silva
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Peter C. Ruben
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- * E-mail:
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104
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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] [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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105
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Zhang N, Liu T, Tse G, Yu S, Fu H, Xu G, Zhou C, Zhang C, Li G. Brugada phenocopy in a patient with acute pulmonary embolism presenting with recurrent syncope. Oxf Med Case Reports 2017; 2017:omx014. [PMID: 28580152 PMCID: PMC5448458 DOI: 10.1093/omcr/omx014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 01/13/2023] Open
Abstract
Brugada phenocopy (BrP) refers to a group of clinical conditions that have etiologies distinct from Brugada syndrome (BrS). Although both demonstrate features of ST-segment elevation in the right precordial leads on the electrocardiogram (ECG), one must be distinguished from the other as their treatment options are different. We report a male patient who presented with recurrent syncope with a Brugada and a S1Q3T3 pattern on the ECG. Acute pulmonary embolism (APE) complicated by BrS was suspected. Twenty-four hours Holter monitoring did not demonstrate any evidence of ventricular arrhythmias. Computed tomography pulmonary angiogram confirmed the presence of an APE. He was treated with low molecular weight heparin and a repeat ECG taken the next day showed resolution of the Brugada and S1Q3T3 patterns. This case report illustrates that APE and BrS can present with similar clinical and electrocardiographic features of recurrent syncope and Brugada pattern, respectively.
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Affiliation(s)
- Nixiao Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, P.R. 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, P.R. China
| | - Gary Tse
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China.,Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China
| | - Shuyu Yu
- Department of Respiration, Tianjin Chest Hospital, Jinnan District, Tianjin, P.R. China
| | - Huaying Fu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, P.R. China
| | - Gang Xu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, P.R. China
| | - Changyu Zhou
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, P.R. China
| | - Chengzong Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, P.R. China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, P.R. China
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106
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Not all ST-segment elevations are myocardial infarction: Hyperkalemia and Brugada phenocopy. Am J Emerg Med 2017; 35:662.e1-662.e2. [DOI: 10.1016/j.ajem.2016.10.063] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 10/27/2016] [Indexed: 11/19/2022] Open
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107
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Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, Gussak I, Hasdemir C, Horie M, Huikuri H, Ma C, Morita H, Nam GB, Sacher F, Shimizu W, Viskin S, Wilde AA. J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge. Europace 2017; 19:665-694. [PMID: 28431071 PMCID: PMC5834028 DOI: 10.1093/europace/euw235] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
| | - Gan-Xin Yan
- Lankenau Medical Center, Wynnewood, Pennsylvania
| | - Michael J. Ackerman
- Departments of Cardiovascular Diseases, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester,Minnesota
| | - Martin Borggrefe
- 1st Department of Medicine–Cardiology, University Medical Centre Mannheim, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Jihong Guo
- Division of Cardiology, Peking University of People's Hospital, Beijing, China
| | - Ihor Gussak
- Rutgers University, New Brunswick, New Jersey
| | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Minoru Horie
- Shiga University of Medical Sciences, Ohtsu, Shiga, Japan
| | - Heikki Huikuri
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital, and University of Oulu, Oulu, Finland
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Gi-Byoung Nam
- Heart Institute, Asan Medical Center, and Department of Internal Medicine, University of Ulsan College of Medicine Seoul, Seoul, Korea
| | - Frederic Sacher
- Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Sami Viskin
- Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arthur A.M. Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands and Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
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108
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Right Ventricular Compression Mimicking Brugada-Like Electrocardiogram in a Patient with Recurrent Pectus Excavatum. Case Rep Cardiol 2017; 2017:3047937. [PMID: 28321340 PMCID: PMC5339422 DOI: 10.1155/2017/3047937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 01/29/2017] [Indexed: 11/17/2022] Open
Abstract
Pectus excavatum (PE), the most common skeletal anomaly of chest wall, sometimes requires a surgical correction but recurrent PE is not uncommon. PE usually has a benign course; however, this chest deformity may be associated with symptomatic tachyarrhythmias due to mechanical compression. We report a case of a patient with recurrent PE after surgical correction presenting with palpitation and electrocardiogram (ECG) showing ST-segment elevation on the right precordial leads, which could be mistaken for a Brugada syndrome (BrS).
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109
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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] [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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110
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Duffett SA, Roberts JD. Brugada Syndrome: Evolving Insights and Emerging Treatment Strategies. J Innov Card Rhythm Manag 2017; 8:2613-2622. [PMID: 32477767 PMCID: PMC7252778 DOI: 10.19102/icrm.2017.080205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 03/10/2017] [Indexed: 12/18/2022] Open
Abstract
Brugada syndrome (BrS) is a rare inherited arrhythmia disorder associated with sudden cardiac death secondary to malignant ventricular arrhythmias. Since its first mention approximately 25 years ago, major strides have been made towards unraveling the condition's genetic and mechanistic underpinnings. Despite considerable progress, however, gaps in the understanding of BrS continue to persist, and clinical management of affected individuals remains challenging. Identification of an underlying genetic culprit continues to be elusive in the majority of patients, while discord regarding the condition's underlying pathophysiology also persists, with strong lines of evidence present for both the "depolarization" and "repolarization" hypotheses. Exciting new therapeutic options hold significant promise, including substrate-based catheter ablation and the subcutaneous implantable cardioverter-defibrillator, although the decision of when to intervene in the cases of asymptomatic patients remains unclear. Provided that the risk of events in BrS is not truly stochastic, distinct sub-phenotypes of the condition, possessing variable levels of arrhythmic risk, may exist, and their identification may lead to the improved care of BrS patients and their families.
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Affiliation(s)
- Stephen A. Duffett
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Jason D. Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
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111
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Martini B, Martini N, Dorantes Sánchez M, Márquez MF, Zhang L, Fontaine G, Nava A. [Clues of an underlying organic substrate in the Brugada Syndrome]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2016; 87:49-60. [PMID: 28038951 DOI: 10.1016/j.acmx.2016.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 10/06/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022] Open
Affiliation(s)
- Bortolo Martini
- Unidad Cardiovascular, Hospital Alto Vicentino, Santorso, Italia.
| | - Nicolò Martini
- Colegio Médico, Universidad de Medicina de Ferrara, Ferrara, Italia
| | - Margarita Dorantes Sánchez
- Servicio de Arritmias y Estimulación Cardiaca, Instituto de Cardiología y Cirugía Cardiovascular, La Habana, Cuba
| | - Manlio F Márquez
- Servicio de Electrocardiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Li Zhang
- Instituto Lankenau de Investigación Médica, Colegio Médico Jefferson, Filadelfia, Estados Unidos
| | - Guy Fontaine
- Unidad de Ritmología, Instituto de Cardiología, Hospital de La Pitié-Salpêtrière, París, Francia
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112
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Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, Gussak I, Hasdemir C, Horie M, Huikuri H, Ma C, Morita H, Nam GB, Sacher F, Shimizu W, Viskin S, Wilde AA. J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge. J Arrhythm 2016; 32:315-339. [PMID: 27761155 PMCID: PMC5063270 DOI: 10.1016/j.joa.2016.07.002] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Gan-Xin Yan
- Lankenau Medical Center, Wynnewood, PA, United States
| | - Michael J. Ackerman
- Departments of Cardiovascular Diseases, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, United States
| | - Martin Borggrefe
- 1st Department of Medicine–Cardiology, University Medical Centre Mannheim, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Jihong Guo
- Division of Cardiology, Peking University of People׳s Hospital, Beijing, China
| | - Ihor Gussak
- Rutgers University, New Brunswick, NJ, United States
| | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Minoru Horie
- Shiga University of Medical Sciences, Ohtsu, Shiga, Japan
| | - Heikki Huikuri
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital, and University of Oulu, Oulu, Finland
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Gi-Byoung Nam
- Heart Institute, Asian Medical Center, and Department of Internal Medicine, University of Ulsan College of Medicine Seoul, Seoul, South Korea
| | - Frederic Sacher
- Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Sami Viskin
- Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arthur A.M. Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands
- Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Saudi Arabia
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113
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Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, Gussak I, Hasdemir C, Horie M, Huikuri H, Ma C, Morita H, Nam GB, Sacher F, Shimizu W, Viskin S, Wilde AAM. J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge. Heart Rhythm 2016; 13:e295-324. [PMID: 27423412 PMCID: PMC5035208 DOI: 10.1016/j.hrthm.2016.05.024] [Citation(s) in RCA: 228] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Indexed: 12/16/2022]
Affiliation(s)
| | - Gan-Xin Yan
- Lankenau Medical Center, Wynnewood, Pennsylvania
| | - Michael J Ackerman
- Departments of Cardiovascular Diseases, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester,Minnesota
| | - Martin Borggrefe
- 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Jihong Guo
- Division of Cardiology, Peking University of People's Hospital, Beijing, China
| | - Ihor Gussak
- Rutgers University, New Brunswick, New Jersey
| | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Minoru Horie
- Shiga University of Medical Sciences, Ohtsu, Shiga, Japan
| | - Heikki Huikuri
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital, and University of Oulu, Oulu, Finland
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Gi-Byoung Nam
- Heart Institute, Asan Medical Center, and Department of Internal Medicine, University of Ulsan College of Medicine Seoul, Seoul, Korea
| | - Frederic Sacher
- Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Sami Viskin
- Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arthur A M Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands and Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
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114
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Boles U, Baranchuk A. Brugada Phenocopy or Unmasked Brugada Syndrome? Relevance of the Provocation Test. J Emerg Med 2016; 50:782. [PMID: 26906547 DOI: 10.1016/j.jemermed.2015.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 11/13/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Usama Boles
- Division of Cardiology, Electrophysiology and Pacing, Queen's University, Kingston General Hospital Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Electrophysiology and Pacing, Queen's University, Kingston General Hospital Kingston, Ontario, Canada
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115
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Ondrejka J, Giorgio G. The Emergency Physician's Role in Differentiating Brugada Syndrome from Brugada Phenotype. J Emerg Med 2016; 50:783. [PMID: 26906546 DOI: 10.1016/j.jemermed.2016.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 11/30/2022]
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116
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117
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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] [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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118
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Warm-up Brugada phenocopy associated with takotsubo cardiomyopathy. Am J Emerg Med 2016; 34:2051.e1-2051.e3. [PMID: 26997494 DOI: 10.1016/j.ajem.2016.02.075] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 02/27/2016] [Accepted: 02/29/2016] [Indexed: 11/20/2022] Open
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119
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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] [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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120
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Ferrando-Castagnetto F, Garibaldi-Remuñan A, Vignolo G, Ricca-Mallada R, Baranchuk A. Brugada Phenocopy as a Dynamic Electrocardiographic Pattern during Acute Anterior Myocardial Infarction. Ann Noninvasive Electrocardiol 2016; 21:425-8. [PMID: 26901086 DOI: 10.1111/anec.12351] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 12/31/2015] [Accepted: 01/04/2016] [Indexed: 11/28/2022] Open
Abstract
Brugada phenocopies represent some unusual clinical cases with identical characteristics to Brugada syndrome (BrS) elicited by various clinical circumstances. We report the case of a woman exhibiting "Brugada Phenocopy" during an acute anterior myocardial infarction, highlighting differential diagnosis with true BrS and discussing possible mechanisms underlying its dynamic ECG pattern.
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Affiliation(s)
- Federico Ferrando-Castagnetto
- Department of Cardiology, University Cardiovascular Center, School of Medicine, Universidad de la República, Montevideo, Uruguay
| | - A Garibaldi-Remuñan
- Department of Cardiology, University Cardiovascular Center, School of Medicine, Universidad de la República, Montevideo, Uruguay
| | - G Vignolo
- Department of Cardiology, University Cardiovascular Center, School of Medicine, Universidad de la República, Montevideo, Uruguay
| | - R Ricca-Mallada
- Department of Cardiology, University Cardiovascular Center, School of Medicine, Universidad de la República, Montevideo, Uruguay
| | - A Baranchuk
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
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121
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Dendramis G. Brugada syndrome and Brugada phenocopy. The importance of a differential diagnosis. Int J Cardiol 2016; 210:25-7. [PMID: 26922708 DOI: 10.1016/j.ijcard.2016.02.097] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/14/2016] [Indexed: 12/22/2022]
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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122
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Gottschalk BH, Baranchuk A. Ischemia-induced Brugada Phenocopy during balloon angioplasty. Int J Cardiol 2016; 205:160. [PMID: 26736092 DOI: 10.1016/j.ijcard.2015.11.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 11/16/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Byron H Gottschalk
- Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
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123
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Agrawal Y, Aggarwal S, Kalavakunta JK, Gupta V. All that looks like "Brugada" is not "Brugada": Case series of Brugada phenocopy caused by hyponatremia. J Saudi Heart Assoc 2016; 28:274-7. [PMID: 27688678 PMCID: PMC5034561 DOI: 10.1016/j.jsha.2016.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 02/05/2016] [Accepted: 02/09/2016] [Indexed: 01/09/2023] Open
Abstract
Brugada syndrome (BS), a life-threatening channelopathy associated with reduced inward sodium current due to dysfunctional sodium channels, is characterized by ST-segment elevation with downsloping “coved type” (type 1) or “saddle back” (type 2) pattern in V1–V3 precordial chest leads (1, 2). Brugada phenocopy, a term describing conditions inducing Brugada-like pattern of electrocardiogram (EKG) manifestations in patients without true BS, is an emerging condition (3). We describe a case series of Brugada phenocopy with hyponatremia.
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Affiliation(s)
- Yashwant Agrawal
- Department of Internal Medicine/Pediatrics and Internal Medicine, Western Michigan University, Homer Stryker School of Medicine, Kalamazoo, MI, aUSA
| | - Sourabh Aggarwal
- Department of Internal Medicine/Pediatrics and Internal Medicine, Western Michigan University, Homer Stryker School of Medicine, Kalamazoo, MI, aUSA
| | - Jagadeesh K Kalavakunta
- Department of Cardiology. Borgess Medical Center/Michigan State University, Kalamazoo, MI, bUSA
| | - Vishal Gupta
- Department of Cardiology. Borgess Medical Center/Michigan State University, Kalamazoo, MI, bUSA
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124
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GOTTSCHALK BYRONH, ANSELM DANIELD, BARANCHUK ADRIAN. Phosphine Poisoning is Emerging as an Important Cause of Brugada Phenocopy. Pacing Clin Electrophysiol 2016; 39:202-3. [DOI: 10.1111/pace.12777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 10/22/2015] [Indexed: 11/27/2022]
Affiliation(s)
- BYRON H. GOTTSCHALK
- Division of Cardiology, Electrophysiology and Pacing; Queen's University, Kingston General Hospital; Kingston Ontario Canada
| | - DANIEL D. ANSELM
- Libin Cardiovascular Institute of Alberta, Foothills Medical Centre; University of Calgary; Calgary Alberta Canada
| | - ADRIAN BARANCHUK
- Division of Cardiology, Electrophysiology and Pacing; Queen's University, Kingston General Hospital; Kingston Ontario Canada
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125
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Peters S. Brugada phenocopy in percutaneous coronary intervention of the right coronary artery. Int J Cardiol 2016; 203:675. [PMID: 26583840 DOI: 10.1016/j.ijcard.2015.08.214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 08/20/2015] [Indexed: 11/16/2022]
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126
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Peters CH, Abdelsayed M, Ruben PC. Triggers for arrhythmogenesis in the Brugada and long QT 3 syndromes. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2016; 120:77-88. [DOI: 10.1016/j.pbiomolbio.2015.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/27/2015] [Accepted: 12/15/2015] [Indexed: 01/16/2023]
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127
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Antzelevitch C, Patocskai B. Brugada Syndrome: Clinical, Genetic, Molecular, Cellular, and Ionic Aspects. Curr Probl Cardiol 2016; 41:7-57. [PMID: 26671757 PMCID: PMC4737702 DOI: 10.1016/j.cpcardiol.2015.06.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Brugada syndrome (BrS) is an inherited cardiac arrhythmia syndrome first described as a new clinical entity in 1992. Electrocardiographically characterized by distinct coved type ST segment elevation in the right-precordial leads, the syndrome is associated with a high risk for sudden cardiac death in young adults, and less frequently in infants and children. The electrocardiographic manifestations of BrS are often concealed and may be unmasked or aggravated by sodium channel blockers, a febrile state, vagotonic agents, as well as by tricyclic and tetracyclic antidepressants. An implantable cardioverter defibrillator is the most widely accepted approach to therapy. Pharmacologic therapy is designed to produce an inward shift in the balance of currents active during the early phases of the right ventricular action potential (AP) and can be used to abort electrical storms or as an adjunct or alternative to device therapy when use of an implantable cardioverter defibrillator is not possible. Isoproterenol, cilostazol, and milrinone boost calcium channel current and drugs like quinidine, bepridil, and the Chinese herb extract Wenxin Keli inhibit the transient outward current, acting to diminish the AP notch and thus to suppress the substrate and trigger for ventricular tachycardia or fibrillation. Radiofrequency ablation of the right ventricular outflow tract epicardium of patients with BrS has recently been shown to reduce arrhythmia vulnerability and the electrocardiographic manifestation of the disease, presumably by destroying the cells with more prominent AP notch. This review provides an overview of the clinical, genetic, molecular, and cellular aspects of BrS as well as the approach to therapy.
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Affiliation(s)
| | - Bence Patocskai
- Masonic Medical Research Laboratory, Utica, NY 13501
- Department of Pharmacology & Pharmacotherapy, University of Szeged, Szeged, Hungary
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128
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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] [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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129
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Gottschalk BH, Garcia-Niebla J, Anselm DD, Glover B, Baranchuk A. Methods for Improving the Diagnosis of a Brugada ECG Pattern. Ann Noninvasive Electrocardiol 2015; 21:210-3. [PMID: 26524486 DOI: 10.1111/anec.12317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 08/28/2015] [Indexed: 11/30/2022] Open
Abstract
Brugada syndrome (BrS) is an inherited channelopathy that predisposes individuals to malignant arrhythmias and can lead to sudden cardiac death. The condition is characterized by two electrocardiography (ECG) patterns: the type-1 or "coved" ECG and the type-2 or "saddleback" ECG. Although the type-1 Brugada ECG pattern is diagnostic for the condition, the type-2 Brugada ECG pattern requires differential diagnosis from conditions that produce a similar morphology. In this article, we present a case that is suspicious but not diagnostic for BrS and discuss the application of ECG methodologies for increasing or decreasing suspicion for a diagnosis of BrS.
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Affiliation(s)
- Byron H Gottschalk
- Department of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Javier Garcia-Niebla
- Sanitary Services of the Salud de El Hierro Area, Valle del Golfo Health Center, Canary Island, Spain
| | - Daniel D Anselm
- Libin Cardiovascular Institute of Alberta, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Benedict Glover
- Department of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Department of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
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130
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Chorin E, Rosso R, Viskin S. Electrocardiographic Manifestations of Calcium Abnormalities. Ann Noninvasive Electrocardiol 2015; 21:7-9. [PMID: 26524386 DOI: 10.1111/anec.12316] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 08/28/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ehud Chorin
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raphael Rosso
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sami Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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131
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Fumi Y, Mizuno A, Niwa K. The Reply. Am J Med 2015; 128:e35. [PMID: 26500209 DOI: 10.1016/j.amjmed.2015.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 06/22/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Yamagami Fumi
- Department of Cardiology, St. Lukes International Hospital, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiology, St. Lukes International Hospital, Tokyo, Japan
| | - Koichiro Niwa
- Department of Cardiology, St. Lukes International Hospital, Tokyo, Japan
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132
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The Reply. Am J Med 2015; 128:e31. [PMID: 26500207 DOI: 10.1016/j.amjmed.2015.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 06/22/2015] [Indexed: 11/22/2022]
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133
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Gottschalk BH, Anselm DD, Baranchuk A. Coronary anomalies resulting in ischemia induced Brugada Phenocopy. Int J Cardiol 2015; 199:75-6. [DOI: 10.1016/j.ijcard.2015.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 07/02/2015] [Indexed: 11/16/2022]
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134
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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: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [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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135
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Aksu U, Kalkan K, Gulcu O, Topcu S, Tanboga IH. Massive pulmonary embolism mimicking electrocardiographic pattern of Brugada syndrome. Am J Emerg Med 2015; 34:933.e1-2. [PMID: 26462902 DOI: 10.1016/j.ajem.2015.09.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/06/2015] [Indexed: 10/23/2022] Open
Abstract
Brugada syndrome is an inherited heart disease without structural abnormalities that is thought to arise as a result of accelerated inactivation of Na channels and predominance of transient outward K current to generate a voltage gradient in the right ventricular layers. Brugada syndrome occurs in patients with structurally normal heart and predisposes patients to malignant ventricular arrhythmias. Acute pulmonary embolism has been associated with a variety of electrocardiograms,and rarely, it may mimic electrocardiographic pattern of Brugada syndrome and this condition was defined as Brugada phenocopy.
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Affiliation(s)
- Uğur Aksu
- Department of Cardiology, Kars State Hospital, Kars, Turkey.
| | - Kamuran Kalkan
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Oktay Gulcu
- Department of Cardiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Selim Topcu
- Department of Cardiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
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136
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Mizuno A, Niwa K. Reader Comments. Proc (Bayl Univ Med Cent) 2015. [DOI: 10.1080/08998280.2015.11929337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Atsushi Mizuno
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Koichiro Niwa
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
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137
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PRABHU MUKUNDA, AGUSTINUS REYNOLD, SHENTHAR JAYAPRAKASH. Suicidal Zinc Phosphide Poisoning Unmasking Brugada Syndrome and Triggering Near Fatal Ventricular Arrhythmia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 39:198-201. [DOI: 10.1111/pace.12749] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/12/2015] [Accepted: 08/25/2015] [Indexed: 11/28/2022]
Affiliation(s)
- MUKUND A. PRABHU
- Department of Cardiology, Electrophysiology Unit; Sri Jayadeva Institute of Cardiovascular Sciences and Research; Bangalore India
| | - REYNOLD AGUSTINUS
- Department of Cardiology, Electrophysiology Unit; Sri Jayadeva Institute of Cardiovascular Sciences and Research; Bangalore India
| | - JAYAPRAKASH SHENTHAR
- Department of Cardiology, Electrophysiology Unit; Sri Jayadeva Institute of Cardiovascular Sciences and Research; Bangalore India
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138
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[Brugada ECG]. Herzschrittmacherther Elektrophysiol 2015; 26:247-59. [PMID: 26249049 DOI: 10.1007/s00399-015-0391-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 07/15/2015] [Indexed: 10/23/2022]
Abstract
The Brugada syndrome (BrS) is characterized by a typical electrocardiogram (ECG) pattern of right precordial ST-segment elevation and the cardinal symptoms syncope and sudden cardiac death as clinical correlate of malignant ventricular arrhythmias in young adults without structural heart disease. The diagnosis of a type 1 Brugada-ECG is based on the documentation of a coved-type (≥ 0.2 mV) ST elevation followed by a negative T wave. The use of the ECG criteria postulated in the consensus of 2012 is helpful to distinguish between saddleback-type 2 (or type 3) J point/ST elevation and incomplete right bundle branch block. Spontaneous or drug-induced type 1 ST elevation can frequently only be detected in a single right precordial lead (V1 or V2), occurs sometimes together with a type 2 (or type 3) pattern in one and the same 12-lead ECG and can sometimes only be seen in modified right precordial leads. The ST elevation is less pronounced in females. Spontaneous and exercise-induced type 1 ST elevation, fragmented QRS complex, prolonged PR interval (> 200 ms), QRS prolongation in V2 (≥ 120 ms) and markers of an increased heterogeneity of ventricular repolarization are associated with an increased arrhythmic risk. The occurrence of spontaneous or dynamic type 1 ST elevation, a macroscopic T wave alternans or pronounced inferior (lateral) J point/ST elevation are signs of acute electrical instability.
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139
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Dendramis G. Coronary anomalies and Brugada Phenocopy, the first documented case in the world. Int J Cardiol 2015; 199:335-6. [PMID: 26241639 DOI: 10.1016/j.ijcard.2015.07.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/07/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Gregory Dendramis
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Diseases, Section of Intensive Coronary Care Unit, University Hospital "Paolo Giaccone", Palermo, Italy.
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140
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Gottschalk BH, Anselm DD, Baranchuk A. Brugada phenocopies are the leading differential diagnosis of Brugada syndrome. Clin Med (Lond) 2015; 15:308-9. [PMID: 26031989 PMCID: PMC4953123 DOI: 10.7861/clinmedicine.15-3-308] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine . Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine@rcplondon.ac.uk
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Affiliation(s)
- Byron H Gottschalk
- Division of Cardiology, Electrophysiology and Pacing, Queen's University, Kingston General Hospital, Kingston, Canada
| | - Daniel D Anselm
- Division of Cardiology, Electrophysiology and Pacing, Queen's University, Kingston General Hospital, Kingston, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Electrophysiology and Pacing, Queen's University, Kingston General Hospital, Kingston, Canada
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141
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Abstract
Brugada syndrome is responsible for up to 4% of all sudden cardiac deaths worldwide and up to 20% of sudden cardiac deaths in patients with structurally normal hearts. Heterogeneity of repolarization and depolarization, particularly over the right ventricle and the outflow tract, is responsible for the arrhythmogenic substrate. The coved Type I ECG pattern is considered diagnostic of the syndrome but its prevalence is very low. Distinguishing between a saddle back Type 2 Brugada pattern and one of many "Brugada-like" patterns presents challenges especially in athletes. A number of criteria have been proposed to assess Brugada ECG patterns. Proper precordial ECG lead placement is paramount. This paper reviews Brugada syndrome, Brugada ECG patterns, and recently proposed criteria. Recommendations for evaluating a Brugada ECG pattern are provided.
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Affiliation(s)
- Eugene H Chung
- Division of Cardiology, Cardiac Electrophysiology, UNC School of Medicine, 160 Dental Circle, CB 7075, Chapel Hill, NC.
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142
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Naseef A, Behr ER, Batchvarov VN. Electrocardiographic methods for diagnosis and risk stratification in the Brugada syndrome. J Saudi Heart Assoc 2015; 27:96-108. [PMID: 25870503 PMCID: PMC4392351 DOI: 10.1016/j.jsha.2014.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 06/02/2014] [Accepted: 06/26/2014] [Indexed: 12/19/2022] Open
Abstract
The Brugada syndrome (BrS) is a malignant, genetically-determined, arrhythmic syndrome manifesting as syncope or sudden cardiac death (SCD) in individuals with structurally normal hearts. The diagnosis of the BrS is mainly based on the presence of a spontaneous or Na + channel blocker induced characteristic, electrocardiographic (ECG) pattern (type 1 or coved Brugada ECG pattern) typically seen in leads V1 and V2 recorded from the 4th to 2nd intercostal (i.c.) spaces. This pattern needs to be distinguished from similar ECG changes due to other causes (Brugada ECG phenocopies). This review focuses mainly on the ECG-based methods for diagnosis and arrhythmia risk assessment in the BrS. Presently, the main unresolved clinical problem is the identification of those patients at high risk of SCD who need implantable cardioverter-defibrillator (ICD), which is the only therapy with proven efficacy. Current guidelines recommend ICD implantation only in patients with spontaneous type 1 ECG pattern, and either history of aborted cardiac arrest or documented sustained VT (class I), or syncope of arrhythmic origin (class IIa) because they are at high risk of recurrent arrhythmic events (up to 10% or more annually for those with aborted cardiac arrest). The majority of BrS patients are asymptomatic when diagnosed and considered to have low risk (around 0.5% annually) and therefore not indicated for ICD. The majority of SCD victims in the BrS, however, had no symptoms prior to the fatal event and therefore were not protected with an ICD. While some ECG markers such as QRS fragmentation, infero-lateral early repolarisation, and abnormal late potentials on signal-averaged ECG are known to be linked to increased arrhythmic risk, they are not sufficiently sensitive or specific. Potential novel ECG-based strategies for risk stratification are discussed based on computerised methods for depolarisation and repolarisation analysis, a composite approach targeting several major components of ventricular arrhythmogenesis, and the collection of large digital ECG databases in genotyped BrS patients and their relatives.
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Key Words
- AP, action potential
- ARI, activation-recovery intervals
- BrS, Brugada syndrome
- Brugada syndrome
- ECG, electrocardiogram
- EPS, electrophysiology study
- Electrocardiogram
- Genetic arrhythmic syndromes
- ICD, implantable cardioverter-defibrillator
- IHD, ischaemic heart disease
- LBBB, left bundle branch block
- MAP, monophasic action potential
- MI, myocardial infarction
- PCA, principal component analysis
- RVOT, right ventricular outflow tract
- Risk stratification
- SAECG, signal-averaged electrocardiogram
- SCD, sudden cardiac death
- SNP, single-nucleotide polymorphism
- Sudden cardiac death
- VF, ventricular fibrillation
- VT, ventricular tachycardia
- WT, wavelet transform
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Affiliation(s)
- Abdulrahman Naseef
- Center for Health Studies, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- Cardiac and Vascular Sciences Research Centre, St. George’s University of London, London, United Kingdom
| | - Elijah R. Behr
- Cardiac and Vascular Sciences Research Centre, St. George’s University of London, London, United Kingdom
| | - Velislav N. Batchvarov
- Cardiac and Vascular Sciences Research Centre, St. George’s University of London, London, United Kingdom
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143
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Gottschalk BH, Anselm DD, Baranchuk A. Brugada syndrome unmasked by ischemia needs full risk evaluation. Intern Emerg Med 2015; 10:111-2. [PMID: 25355502 DOI: 10.1007/s11739-014-1145-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 10/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Byron Hadley Gottschalk
- Division of Cardiology, Electrophysiology and Pacing, Kingston General Hospital K7L 2V7, Queen's University, Kingston, ON, Canada,
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144
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Marchetti M, Sierecki M, Oriot D, Ghazali A. Brugada-type ECG associated with pectus excavatum. IMAGES IN PAEDIATRIC CARDIOLOGY 2015; 17:1-2. [PMID: 26865849 PMCID: PMC4727570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- M Marchetti
- aDepartment of Emergency Medicine, University Hospital Center of Poitiers, Poitiers, France
| | - M Sierecki
- aDepartment of Emergency Medicine, University Hospital Center of Poitiers, Poitiers, France
| | - D Oriot
- bDepartment of Paediatrics Emergencies, University Hospital Center of Poitiers, Poitiers, France
| | - A Ghazali
- aDepartment of Emergency Medicine, University Hospital Center of Poitiers, Poitiers, France
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145
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Brugada phenocopy in the context of intracranial hemorrhage. Int J Cardiol 2014; 177:e156-7. [DOI: 10.1016/j.ijcard.2014.08.151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 08/26/2014] [Indexed: 01/15/2023]
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146
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Anselm DD, Gottschalk BH, Baranchuk A. Brugada Phenocopies: Consideration of Morphologic Criteria and Early Findings From an International Registry. Can J Cardiol 2014; 30:1511-5. [DOI: 10.1016/j.cjca.2014.09.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/12/2014] [Accepted: 09/18/2014] [Indexed: 10/24/2022] Open
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147
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Batchvarov VN. The Brugada Syndrome - Diagnosis, Clinical Implications and Risk Stratification. Eur Cardiol 2014; 9:82-87. [PMID: 30310491 PMCID: PMC6159405 DOI: 10.15420/ecr.2014.9.2.82] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 11/24/2014] [Indexed: 12/19/2022] Open
Abstract
The Brugada syndrome (BrS) is a hereditary arrhythmic syndrome manifesting as syncope or sudden cardiac death (SCD) in individuals without overt structural heart disease. Currently, its diagnosis is mainly based on the presence of a spontaneous or Na+-channel blocker induced so-called "type 1" Brugada electrocardiographic (ECG) pattern typically seen in leads V1 and V2 recorded from the 4th to 2nd intercostal spaces. Presently the main unresolved clinical problem in the BrS is the identification of patients at high risk of SCD who need implantable cardioverter-defibrillator (ICD). Current guidelines recommend ICD implantation only in patients with spontaneous type 1 ECG pattern and either history of aborted cardiac arrest or documented sustained ventricular tachycardia (class I) or syncope of arrhythmic origin (class IIa) because they are at high risk of recurrent arrhythmias. However, the majority of BrS patients are asymptomatic when diagnosed and have generally low risk (0.5 % annually or lower) and therefore are not indicated for ICD. Most of SCD victims in the BrS have had no symptoms prior to the fatal event and therefore were not protected with an ICD. Currently there are no reliable methods to identify these potential victims of SCD. Although some ECG markers such as QRS fragmentation and infero-lateral early repolarisation have been demonstrated to signify increased arrhythmic risk their value still needs to be confirmed in large prospective studies. Novel risk assessment strategies need to be developed based on computerised quantitative ECG analysis of large digital ECG databases in patients with BrS and their relatives, and combined assessment of the most important factors of ventricular arrhythmogenesis.
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Affiliation(s)
- Velislav N Batchvarov
- Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
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148
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Gottschalk BH, Anselm DD, Baranchuk A. Brugada phenocopy induced by ischemia or Brugada syndrome unmasked by ischemia? Int J Cardiol 2014; 177:619-20. [DOI: 10.1016/j.ijcard.2014.09.112] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 09/20/2014] [Indexed: 11/25/2022]
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149
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Anselm DD, Genaro NR, Baranchuk A. Possible brugada phenocopy induced by hypokalemia in a patient with congenital hypokalemic periodic paralysis. Arq Bras Cardiol 2014; 102:104. [PMID: 24652091 PMCID: PMC3987399 DOI: 10.5935/abc.20130249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 07/23/2013] [Indexed: 12/23/2022] Open
Affiliation(s)
- Daniel D Anselm
- Queen's University, Kingston General Hospital, Departamento de Cardiologia, Eletrofisiologia e Ritmo Cardíaco, Ontario, Canada
| | | | - Adrian Baranchuk
- Queen's University, Kingston General Hospital, Departamento de Cardiologia, Eletrofisiologia e Ritmo Cardíaco, Ontario, Canada
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150
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Gottschalk B, Anselm DD, Baranchuk A. Brugada phenocopy: morphological classification and importance of provocative testing. Ann Noninvasive Electrocardiol 2014; 19:604-5. [PMID: 25201124 DOI: 10.1111/anec.12207] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Byron Gottschalk
- Division of Cardiology, Electrophysiology and Pacing, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
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