Coronary anomalies resulting in ischemia induced Brugada Phenocopy

Coronary anomalies and Brugada Phenocopy, the first documented case in the world

“…As said by Byron H Gottschalk et al, this is the first description present in the literature to date of confirmed BrP due to an anomaly in the coronary circulation and it provides evidence that atypical causes of myocardial ischemia may induce BrP and the diagnosis should be considered in such cases [4].…”

“…The authors concluded that given the headquarters of this coronary artery fistula, a temporary ischemia at the level of the RVOT could determine a temporary transmural dispersion of repolarization or slow conduction, which could be at the base of the manifestation of Brugada type I ECG pattern in this patient. In fact, at the spontaneous restoration of a regular coronary artery flow at the level of the RVOT, obtained thanks to drug therapy or to a probable spontaneous fibrinolysis, the electrocardiographic manifestations did not appear more.Therefore, at the manifestation of a BrP, patients should be carefully studied because different therapeutic approaches are required for patients with BrP than in patients with true BrS [1].As said by Byron H Gottschalk et al, this is the first description present in the literature to date of confirmed BrP due to an anomaly in the coronary circulation and it provides evidence that atypical causes of myocardial ischemia may induce BrP and the diagnosis should be considered in such cases [4].I agree with Byron H Gottschalk that we have to use the terminology Brugada Phenocopy in future manuscripts for consistency in the literature and to facilitate research on the phenomenon. …”

Brugada Phenocopy as a Dynamic Electrocardiographic Pattern during Acute Anterior Myocardial Infarction

“…This remains an important task to be resolved since ischemia may either induce a BrP or, inversely, unmask a true congenital BrS . In this clinical situation, current criteria allowed us to confirm the diagnosis of Type‐1, Class B BrP . Although the case presented here would require a challenge with a sodium channel blocker (ajmaline, flecainide, or procainamide), we did not perform these tests given the severe life‐threatening clinical situation and complete reversal of the ECG pattern once myocardial ischemia resolved.…”

Brugada Type 1 Pattern and Risk Stratification for Sudden Death: Does the Key Hide in the ECG Analysis?

“…Several clinical cases highlight many underlying conditions. Type 1 Brugada phenocopies have been observed in various cardiac diseases (myocardial ischemia such inferior infarction with right ventricle extension or anterior infarction [7][8][9], Tako-Tsubo cardiomyopathy [10], cardiac tumors [11], Chagas disease [12]), in pulmonary and mediastinal diseases (acute pulmonary embolism [13], pneumothorax [14], mediastinal tumors [15]), in metabolic and hydroelectrolytic disorders (hypokalemia [16,17], hyperkalemia [18], hyponatremia [19], hypophosphatemia [20], keto-acidosis [21]), in intoxications (heroin and ethanol overdose [22], propofol [23], propafenone [24], yellow phosphorus [25], lamotrigine [26], phosphine [27]), and various diseases such intracranial hemorrhages [28], hypothermia [29], and electrocution [30]. Pectus excavatum can also mimic a type 1 pattern [31].…”