Brugada Phenocopy: New Terminology and Proposed Classification

Abstract

Brugada syndrome is a channelopathy characterized on ECG by coved ST-segment elevation (≥2 mm) in the right precordial leads and is associated with an increased risk of malignant ventricular arrhythmias. The term Brugada phenocopy is proposed to describe conditions that induce Brugada-like ECG manifestations in patients without true Brugada syndrome. An extensive review of the literature identified case reports that were classified according to their suspected etiological mechanism. Future directions to learn more about these intriguing cases is discussed.

Coronary anomalies resulting in ischemia induced Brugada Phenocopy

“…BrPs are clinical entities that present with ECGs identical to those found in Brugada Syndrome (BrS) but are the result of various clinical circumstances [2,3]. They may be induced by a number of clinical conditions that are characterized into six etiological categories: (i) metabolic conditions; (ii) mechanical compression; (iii) myocardial ischemia & pulmonary embolism; (iv) myocardial & pericardial disease; (v) ECG modulations; and (vi) miscellaneous [4].…”

Unusual ST-Segment Elevation in the Anterolateral Precordial Leads

“…3 The potential mechanisms and pathophysiology underlying BrP remain unclear. BrPs have been reported under a multitude of clinical circumstances in the following distinct etiologic categories 1,2 : metabolic conditions, endocrine disease (ie, hypopituitarism), electrolyte imbalances, mechanical compression (mediastinal tumors, pectus excavatum), ischemia-induced (the present case), myocardial and pericardial disease, acute pulmonary embolism, and others. For a detailed list of conditions, please refer to the Educational Portal and International Registry on Brugada Phenocopies (www.brugadaphenocopy.com).…”

Brugada Syndrome: Evolving Insights and Emerging Treatment Strategies

“…In cases in which the ECG normalizes following removal of the clinical insult or condition, a subsequent provocative drug fails to induce a type 1 pattern and/or genetic testing is negative, experts have suggested to label these cases as Brugada phenocopies. 40 The rationale for this alternative terminology is as an attempt to differentiate these cases from typical BrS, as they are presumed to have a non-genetic etiology and carry a more benign prognostic significance. This nomenclature remains controversial, however, as our limited understanding of the genetic culprits of BrS limits our ability to exclude an underlying genetic predisposition.…”