Electrocution-induced Brugada phenocopy

Abstract

Brugada Syndrome (BrS) is a clinical-electrocardiographic entity predisposing to ventricular arrhythmia and sudden cardiac death. [1] The BrS electrocardiogram is often dynamic, and can change from a “coved” type-1 to a “saddleback” type II pattern to periods of transient normalization [1]. The BrS signature may be initially apparent or be concealed, requiring unmasking with sodium channel blockers or a febrile state. A series of loss-of-function mutations in the sodium channel SCN5a have been linked to the BrS pattern [1]. The term Brugada phenocopy was proposed by Perez-Riera et al [2]. to describe the Brugada pattern seen in patients with other diseases, such as chronic Chagasic cardiomyopathy, acute myocarditis or Duchenne muscular dystrophy [3], or secondary to other agents [4]. One study has suggested that patients in an acute situation who present with a Brugada phenocopymay be at an increased risk of sudden cardiac death [5]. Electrical injuries can result in severe cardiovascular alterations, including malignant ventricular arrhythmias and sudden cardiac death [6]. Approximately 1000 people die due to electrical injury annually in the United States [7], but the mechanism of fatality associated with electrical injuries is unknown. We report the case of a spontaneous, transient Brugada phenocopy seen in a patient after an electrocution event. A 52-year-oldman presented to the emergency department one hour after sustaining a 120-volt electrical injury while repairing the lighting