Transient Brugada phenocopy during evolving ischemic right bundle branch block

Abstract

A “Brugada phenocopy” (BrP) is a clinical presentation exhibiting the same electrocardiographic characteristics of true Brugada syndrome (BrS) in different clinical scenarios. We report the clinical case of a 59-year-old male patient with acute chest pain depicting BrP followed by extensive convex ST-segment elevation due to proximal thrombosis of the left descending coronary artery. Following successful percutaneous intervention and drug-eluting stent implantation, a classical right bundle branch block pattern emerged. We discussed possible mechanism and clinical implications of this unusual electrical sequence during acute myocardial injury.

Brugada phenocopy secondary to extensive inferior wall ischemia induced by coronary steal effect

“…The involvement of the right ventricle during myocardial ischemia, acute pulmonary embolism, and mechanical compression can cause ECG changes identical to type‐1 BrS pattern (Brugada et al, ). We described the appearance of BrP during transmural myocardial ischemia associated with acute thrombosis of the anterior descending artery (Ferrando‐Castagnetto, Garibaldi‐Remuñan, Vignolo, Ricca‐Mallada, & Baranchuk, ; Ferrando‐Castagnetto, Rivara, Vignolo, Ricca‐Mallada, & Baranchuk, ). BrP associated with ischemia is manifested mainly through type‐1 Brugada ECG pattern, predominately in men, and the coronary artery most frequently involved was the RCA (65%).…”