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LETTER TO EDITOR
Year : 2018  |  Volume : 7  |  Issue : 5  |  Page : 1141-1142  

Brugada phenocopy due to hypokalemia


Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada

Date of Web Publication20-Nov-2018

Correspondence Address:
Prof. Adrian Baranchuk
Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario K7L 2V7
Canada
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_64_17

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How to cite this article:
Baranchuk A, Antiperovitch P, Gottschalk BH. Brugada phenocopy due to hypokalemia. J Family Med Prim Care 2018;7:1141-2

How to cite this URL:
Baranchuk A, Antiperovitch P, Gottschalk BH. Brugada phenocopy due to hypokalemia. J Family Med Prim Care [serial online] 2018 [cited 2019 Nov 12];7:1141-2. Available from: http://www.jfmpc.com/text.asp?2018/7/5/1141/245780



Dear Editor,

We read with interest the illustrative case of Swe and Dogar, recently published in your journal.[1] They presented a case of a patient with hypokalemia depicting a surface 12-lead electrocardiography (ECG) of Brugada ECG pattern which immediately resolved upon correction of electrolyte imbalance. The case presented by the authors refers to a possible Brugada phenocopy (BrP).[2]

BrPs are clinical entities characterized by ECG patterns identical to those of true Brugada syndrome (BrS) but are elicited by various other underlying conditions.[2],[3] Differentiation between the two conditions is of utmost importance as the treatment recommendations of BrP differ from BrS and misdiagnosis may lead to significant morbidity and mortality. While individuals with BrS are at risk of sudden cardiac death, and may be candidates for an implantable cardioverter-defibrillator, the clinical implications of BrP remain unknown. However, the BrP International Registry[4] reveals that prognosis of BrP seems to be associated with the underlying condition rather than with the presence of polymorphic ventricular arrhythmias as it occurs with true BrS. Diagnosis of BrP relies on a series of electrocardiographic and clinical characteristics that distinguish the condition from BrS [Table 1].[2] Perhaps the most important component in the reliable distinction between BrS and BrP is the use of a sodium channel blocking agent.
Table 1: Brugada phenocopy systematic diagnostic criteria (reproduced with permission)

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According to the morphological classification of BrP,[2] the case presented by Swe and Dogar[1] represents a BrP type 1, class B (as the sodium channel blocker test has not been performed). We make a call for researchers to use the proposed terminology (BrP) to identify cases like the one presented here.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Swe T, Dogar MH. Type 1 brugada pattern electrocardiogram induced by hypokalemia. J Family Med Prim Care 2016;5:709-11.  Back to cited text no. 1
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2.
Anselm DD, Gottschalk BH, Baranchuk A. Brugada phenocopies: Consideration of morphologic criteria and early findings from an international registry. Can J Cardiol 2014;30:1511-5.  Back to cited text no. 2
    
3.
Gottschalk BH, Anselm DD, Brugada J, Brugada P, Wilde AA, Chiale PA, et al. Expert cardiologists cannot distinguish between brugada phenocopy and brugada syndrome electrocardiogram patterns. Europace 2016;18:1095-100.  Back to cited text no. 3
    
4.
Gottschalk BH, Anselm DD, Baranchuk A. Brugada Phenocopy International Registry and Online Educational Porta. Available from: http://www.brugadaphenocopy.com. [Last accessed on 2018 July 01].  Back to cited text no. 4
    



 
 
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