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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] [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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Captagon-induced Brugada phenocopy: A report of two cases. J Electrocardiol 2023; 79:21-23. [PMID: 36913784 DOI: 10.1016/j.jelectrocard.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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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3
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Greffie ES, Alhalaseh S, Zaremski L. Not All ST Elevation Is STEMI: Brugada Phenocopy Induced by Hyperkalemia. Cureus 2023; 15:e36951. [PMID: 37139283 PMCID: PMC10151112 DOI: 10.7759/cureus.36951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
Brugada syndrome (BrS) is a hereditary channelopathy associated with malignant ventricular arrhythmia and sudden death in individuals with a structurally normal heart. It is characterized by an ST-segment elevation in the precordial leads. Brugada phenocopy (BrP) is a term given to conditions that could result in ST morphologies identical to those found in Brugada syndrome (Brugada pattern electrocardiogram (EKG) changes) without the actual channelopathy responsible for Brugada syndrome. BrP is a rare EKG manifestation of hyperkalemia, commonly seen at high serum levels of potassium, and associated with malignant arrhythmia. Here, we present a case with Brugada pattern EKG changes associated with hyperkalemia and metabolic acidosis, which normalized after correcting the electrolyte abnormalities. In this case, we also wanted to highlight that not all ST-segment elevation is due to myocardial infarction (MI). In young patients with no coronary artery disease (CAD) risk factors, other potential ST elevation causes should be considered.
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Affiliation(s)
- Ermias S Greffie
- Internal Medicine, St. Barnabas Hospital (SBH) City University of New York (CUNY) School of Medicine, Bronx, USA
| | - Saleh Alhalaseh
- Internal Medicine, St. Barnabas Hospital (SBH) City University of New York (CUNY) School of Medicine, Bronx, USA
| | - Lynn Zaremski
- Medicine/Cardiology, St. Barnabas Hospital (SBH) City University of New York (CUNY) School of Medicine, Bronx, USA
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4
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Rajendran G, Mahalingam S, Ganessane E. Unusual Presentation of a Common Diagnosis in a Patient With Chronic Kidney Disease. JAMA Intern Med 2023; 183:70-71. [PMID: 36342710 DOI: 10.1001/jamainternmed.2022.4716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This case report describes a patient in their 40s with chronic kidney disease who presented to the emergency department with acute-onset breathlessness for 2 hours.
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Affiliation(s)
- Gunaseelan Rajendran
- Department of Emergency Medicine, Aarupadai Veedu Medical College and Hospital, Puducherry, India
| | - Sasikumar Mahalingam
- Department of Emergency Medicine, Aarupadai Veedu Medical College and Hospital, Puducherry, India
| | - Ezhilkugan Ganessane
- Department of Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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5
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Amusina O, Mehta S, Nelson ME. Brugada phenocopy secondary to hyperkalemia and hyponatremia in primary adrenal insufficiency. J Am Coll Emerg Physicians Open 2022; 3:e12800. [PMID: 35978657 PMCID: PMC9365237 DOI: 10.1002/emp2.12800] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction The Brugada phenocopy represents electrocardiogram (ECG) changes nearly identical to the Brugada syndrome but without the congenital abnormality associated with lethal arrhythmias and normalizes with treatment of the underlying etiology. This case highlights the Brugada phenocopy in the setting of moderate hyperkalemia and severe hyponatremia from adrenal insufficiency that resolves with treatment of the underlying metabolic disturbance. Case Report A 26-year-old man with no prior medical history presented to the emergency department with syncope, and his ECG revealed a Brugada-like pattern. The patient was found to have significant metabolic derangements, including severe hyponatremia (94 mEq/L), moderate hyperkalemia (6.1 mEq/L), severe hypochloremia (<60 mEq/L), acute kidney injury, and rhabdomyolysis. The patient was diagnosed with primary adrenal insufficiency, and electrolyte correction led to resolution of the Brugada phenocopy. Conclusion The Brugada phenocopy on ECG can occur with severe hyponatremia and moderate hyperkalemia and quickly resolves with electrolyte correction.
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Affiliation(s)
- Olga Amusina
- NorthShore University HealthSystemEvanstonIllinoisUSA
- College of NursingUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Sandeep Mehta
- NorthShore University HealthSystemEvanstonIllinoisUSA
| | - Michael E. Nelson
- NorthShore University HealthSystemEvanstonIllinoisUSA
- John H. Stroger Jr. Hospital of Cook CountyCook County HealthChicagoIllinoisUSA
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Noori MAM, Fichadiya H, Jesani S, Abid F, Sachdeva N, Saeed H, Jawed Q, Elkattawy S, Joshi M. A Rare yet Morbid Complication of Cocaine Use: Brugada Type 1 on Electrocardiogram. Cureus 2022; 14:e24309. [PMID: 35602832 PMCID: PMC9122013 DOI: 10.7759/cureus.24309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/05/2022] Open
Abstract
Cocaine is considered a leading non-opioid cause of drug overdose in the US. It acts as a sympathomimetic and increases the amount of catecholamines, thereby increasing the risk of ventricular irritability and resultant arrhythmias. Its sodium (Na) channel blockage is the principal mechanism behind the Brugada pattern on an electrocardiogram (ECG), which is often transient but is indistinguishable from that of Brugada syndrome, the autosomal dominant channelopathy. We are presenting a case of a 32-year-old male with a history of cocaine and nicotine abuse, who sought medical attention for sudden-onset palpitations and pressure-like chest pain after having snorted an impressive amount of cocaine. His ECG depicted a classical Brugada pattern with ST-elevation with T inversion in V1; however, previous ECGs were normal without ST changes, signifying the Brugada pattern unmasked by cocaine use. Other investigations including stress tests and nuclear imaging were equivocal. His symptoms as well as the ECG pattern reverted to baseline signifying the presence of Brugada phenotype in the absence of channelopathy. Hence, as a sodium channel blocker, cocaine may unmask latent Brugada syndrome in asymptomatic patients without a family history. Recognizing Brugada syndrome on ECG is vital to avoid misdiagnosis and mistreatment of the patient with and without a genetic predisposition.
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Abstract
Brugada syndrome (BrS) is an inherited cardiac arrhythmia syndrome that causes a heightened risk for ventricular tachyarrhythmias and sudden cardiac death. BrS is characterised by a coved ST-segment elevation in right precordial leads. The prevalence is estimated to range between 1 in 5,000 to 1 in 2,000 in different populations, with the highest being in Southeast Asia and in males. More than 18 genes associated with BrS have been discovered and recent evidence has suggested a complex polygenic mode of inheritance with multiple common and rare genetic variants acting in concert to produce the BrS phenotype. Diagnosis of BrS in patients currently relies on presentation with a type-1 Brugada pattern on ECG either spontaneously or following a drug provocation test using a sodium channel blocker. Risk assessment in patients diagnosed with BrS is controversial, especially with regard to the predictive value of programmed electrical stimulation and novel ECG parameters, such as QRS fragmentation. The first line of BrS therapy remains an implantable cardioverter defibrillator (ICD), although radiofrequency catheter ablation has been shown to be an effective option in patients with contraindications for an ICD. True BrS can be unmasked on ECG in susceptible individuals by monitoring factors such as fever, and this has been recently evident in several patients infected with the 2019 novel coronavirus (COVID-19). Aggressive antipyretic therapy and regular ECG monitoring until fever resolves are current recommendations to help reduce the arrhythmic risk in these COVID-19 patients. In this review, we summarise the current knowledge on the epidemiology, pathophysiology, genetics, clinical diagnosis, risk stratification and treatment of patients with BrS, with special emphasis on COVID-19 comorbidity.
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Affiliation(s)
| | - Giridhar Korlipara
- Cardiology Division of Department of Medicine, Renaissance School of Medicine, Stony Brook Medical Center, Stony Brook, NY, USA
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Manne JRR, Garg J. Hyperkalemia induced Brugada phenocopy. J Arrhythm 2021; 37:249-250. [PMID: 33664911 PMCID: PMC7896447 DOI: 10.1002/joa3.12498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/23/2020] [Accepted: 12/19/2020] [Indexed: 01/12/2023] Open
Abstract
We illustrate the case Brugada Type 1 pattern on electrocardiogram in a setting of hyperkalemia, changes which were reversible following normalization of serum potassium levels. Although Brugada Type 1 syndrome is associated with sudden cardiac death, a quick search for alternate reversible pathology is essential to timely management and avoid unnecessary cardiac intervention.
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Affiliation(s)
| | - Jalaj Garg
- Division of CardiologyCardiac Arrhythmia ServiceMedical College of WisconsinMilwaukeeWIUSA
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9
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Sáenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace 2020; 21:1143-1144. [PMID: 31075787 DOI: 10.1093/europace/euz132] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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10
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Bella PD, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Interv Card Electrophysiol 2020; 59:145-298. [PMID: 31984466 PMCID: PMC7223859 DOI: 10.1007/s10840-019-00663-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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11
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Brugada Phenocopy Type 1 Secondary to Synthetic Cannabinoids. Case Rep Cardiol 2020; 2020:9425860. [PMID: 32655955 PMCID: PMC7330635 DOI: 10.1155/2020/9425860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/03/2020] [Accepted: 06/17/2020] [Indexed: 12/02/2022] Open
Abstract
Brugada phenocopies (BrP) are clinical entities that have EKG tracings similar to the congenital Brugada syndrome (BrS) but without ventricular tachyarrhythmias or sudden cardiac death. BrP is caused by various factors such as metabolic disturbances (electrolyte imbalance), drugs, mechanical compression of the mediastinum, and inflammatory conditions such as myocarditis or pericarditis. We present a very rare case of a young patient who had a Brugada phenocopy Type 1 suspected to be secondary to synthetic cannabinoids.
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12
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Dendramis G, Sgarito G, Comparato C, Corrao S, Baranchuk A. Brugada phenocopy in diabetic ketoacidosis, the importance of the diagnostic approach. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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de Oliveira Neto NR, de Oliveira WS, Mastrocola F, Sacilotto L. Brugada phenocopy: Mechanisms, diagnosis, and implications. J Electrocardiol 2019; 55:45-50. [DOI: 10.1016/j.jelectrocard.2019.04.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/08/2019] [Accepted: 04/30/2019] [Indexed: 02/06/2023]
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14
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm 2019; 17:e2-e154. [PMID: 31085023 PMCID: PMC8453449 DOI: 10.1016/j.hrthm.2019.03.002] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 01/10/2023]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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15
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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 AND CLINICAL ELECTROPHYSIOLOGY: PACE 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] [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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Ramsaroop K, Seecheran R, Seecheran V, Persad S, Giddings S, Mohammed B, Seecheran NA. Suspected hyponatremia-induced Brugada phenocopy. Int Med Case Rep J 2019; 12:61-65. [PMID: 30881148 PMCID: PMC6398420 DOI: 10.2147/imcrj.s200201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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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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] [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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Littmann L, Gibbs MA. Electrocardiographic manifestations of severe hyperkalemia. J Electrocardiol 2018; 51:814-817. [DOI: 10.1016/j.jelectrocard.2018.06.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 06/30/2018] [Indexed: 11/29/2022]
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Affiliation(s)
- Javier García-Niebla
- Servicios Sanitarios del Área de Salud de El Hierro, Valle del Golfo Health Center, Islas Canarias, Spain
| | - Antonio Bayés de Luna
- Institut Catala d'Ciencies Cardiovasculars, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
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