Brugada Phenocopy in a Patient with Pectus Excavatum: Systematic Review of the ECG Manifestations Associated with Pectus Excavatum

Abstract

Brugada phenocopies (BrP) have emerged as new clinical entities that are etiologically distinct from true Brugada syndrome (BrS). BrP are characterized by an ECG pattern that is phenotypically identical to true BrS (type 1 or type 2); however, BrP are caused by various other factors such as mechanical mediastinal compression, myocardial ischemia, pericarditis, myocarditis, pulmonary embolism, and metabolic disturbances. We report a case of an electrocardiographic BrP in a patient with pectus excavatum deformity in the absence of true BrS using currently defined BrP diagnostic criteria. A systematic review of ECG manifestations associated with pectus excavatum is also discussed.

Pectus Excavatum: Uncommon Electrical Abnormalities Caused by Extrinsic Right Ventricular Compression

“…Many ECG abnormalities have been associated with pectus excavatum, including the Brugada pattern . However, these were reported in asymptomatic individuals, whereas in our patient, the concomitant presence of symptomatic VT raised concerns about whether the patient did indeed have the Brugada syndrome.…”

Differential Diagnosis of rSr’ Pattern in Leads V1-V2. Comprehensive Review and Proposed Algorithm

“…In these patients, the rSr’ pattern is most likely the consequence of a change on the direction of the third vector, which due to thoracic deformity and change of heart location within the thorax, faces leads V 1 ‐V 2 . This produces a peaked r´ of fast inscription in lead V1 followed by an ST‐segment with descending slope and very small, if exist, ST‐segment ascent.…”

Brugada phenocopy in a patient with acute pulmonary embolism presenting with recurrent syncope

“…BrPs are clinical entities characterized by ECG patterns similar or identical to those of BrS, which are caused by underlying disorders such as metabolic disturbances, mechanical compression, ischemia, myocardial and pericardial diseases [9–14]. BrP can be observed in patients with sub-massive to massive APE, with the latter being accompanied by hypotension and cardiogenic shock.…”