Brugada-like electrocardiography pattern induced by severe hyponatraemia

Abstract

The characteristic electrocardiographic (ECG) findings of Brugada syndrome, specifically the down sloping coved elevation of the ST-segment ending in an inverted T-wave in the right precordial leads, have been linked to reduced inward sodium current due to dysfunctional sodium channels. Additionally, however, many sodium channel blocking agents are known to either unmask or induce this ECG pattern. Severe hyponatraemia may be expected to have the same effect by reducing inward sodium current. Here, we report a case in which the presenting ECG exhibited a 'Brugada-like' pattern during severe isolated hyponatraemia, with subsequent normalization as hyponatraemia improved.

A Brugada-like electrocardiogram pattern induced after radiofrequency catheter ablation of atrial fibrillation

“…Be afraid of inducibility of sustained life-threaten ventricular arrhythmias during programmed ventricular stimulation of the heart, the patient declined our suggestion of a further evaluation of electrophysiological test. Several medications or conditions including severe hyponatremia, mutation of the SCN5A gene and so on that may cause loss of cardiac sodium channel function in the ventricular epicardium induce ECG findings of ST elevations in precordial leads that resemble the Brugada pattern [8,10]. In the cases we present, we could not detect direct or indirect evidence of drugs or other conditions such as hyperkalemia, severe hyponatremia and so on that may lead to Brugada-like pattern of ECG in individuals.…”

Isolated Tramadol Overdose Associated with Brugada ECG Pattern

“…Multiple other conditions are associated with a Brugada ECG pattern. These include fever, 9 hyperkalemia, 10 hyponatremia, 11,12 cocaine toxicity, 13 and overdose with phenytoin 14 or tricyclic antidepressants 2 . Our patient had none of these conditions, which could potentially influence the ECG findings noted.…”

Brugada Phenocopy: New Terminology and Proposed Classification

“…Thirty‐one cases were identified as meeting our inclusion criteria 72–102 . To confirm these cases as manifestations of Brugada phenocopies, we first sought to assess the clinical probability that the patients had true Brugada syndrome.…”