Brugada-like Electrocardiogram Research Articles

Syncope and Brugada-like ECG pattern in a patient with syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Syncope is a brief loss of consciousness caused by reduced blood flow to the brain, characterised by sudden onset, short duration and full recovery without intervention. Anamnesis, physical examination and other diagnostic tests such as laboratory analysis and electrocardiogram (ECG) can be conducted to identify the underlying cause of syncope. A Brugada pattern on an ECG in individuals with syndrome of inappropriate antidiuretic hormone secretion (SIADH) who have syncope symptoms may indicate cardiac issues. A 69-year-old man with hypertension and a history of smoking presented with syncope. His vital signs were within normal limits, with no signs of a neurological deficit. The patient met the diagnostic criteria for SIADH, as evidenced by the presence of hyponatraemia (Na 118 mmol/l), a hyperosmolar condition and euvolemia. Upon arrival, a twelve-lead ECG showed ST-segment anomalies that reflected a Brugada ECG pattern. No ventricular arrhythmias were detected during the 24-hour Holter monitoring. Coronary angiography revealed no abnormalities in the coronary arteries. The ECG demonstrated the normalisation of ST elevations and the disappearance of the Brugada ECG pattern after the correction of hyponatraemia. After three months of follow-up the patient, with a normal sodium level, had no episodes of syncope.

CASE REPORT: BRUGADA- LIKE ECG PATTERN IN PATIENT AFTER SUCH AS LONG-TERM OUTCOME OF COVID-19

This article presents a clinical case of a patient who developed a Brugada-like electrocardiogram (ECG) pattern as a delayed complication after recovering from COVID-19. Brugada syndrome is a rare genetic disorder characterized by abnormal changes on the ECG and an increased risk of sudden cardiac death. Although the association between COVID-19 and cardiovascular complications is well-studied, the development of Brugada-like ECG changes in COVID-19 patients is a rare occurrence. This clinical case emphasizes the importance of early detection and appropriate management of cardiac complications in patients recovering from COVID-19, including the development of Brugada-like ECG changes. Consideration of these factors is crucial for optimal patient care and reducing the risk of sudden cardiac death.

Brugada-like electrocardiogram pattern in a young man taking a proton-pump inhibitor

The Brugada syndrome (BrS) is an electrical heart disease with complex inheritance (some cases with SCN5A mutations), characterized by specific electrocardiogram (ECG) markers and high risk of associated lethal ventricular arrhythmias [1]. The ECG signature of BrS consists of right precordial ST-segment elevation (≥2 mm) followed by negative T waves [1]. It sometimes includes the findings of right bundle branch block (RBBB). In certain cases, the typical ECG pattern is present intermittently which creates a potential problem for reaching the diagnosis of BrS. Another problem in diagnosing BrS is the presence of so-called Brugada phenocopies (BrPs), i.e. an acquired Brugada-like ECG pattern that are visually identical and indistinguishable from true BrS [2]. This ECG pattern can be caused by other conditions including ischemia of the ventricular septum and/or right ventricle or by taking certain medications [2]. Proton-pump inhibitors (PPIs) are widely prescribed, often for prolonged use, and have been associated with electrolyte disturbances and cardiac arrhythmias [3,4]. We hereby present for the first time the case of a patient with an ECG suggestive of BrS while taking PPI; but no other medication known to cause BrS. The BrS ECG pattern disappeared a few months after stopping the medication.

Transient Brugada-Like Electrocardiographic Pattern in a Patient With COVID-19

A 61-year-old man presented with fever, shortness of breath, and new chest pain. An electrocardiogram (ECG) revealed Brugada-like ECG pattern. Emergent coronary angiography demonstrated normal coronary arteries. He was subsequently diagnosed with COVID-19. After a few days he felt better and the ECG Brugada-like pattern resolved.

Brugada-like ECG Pattern in COVID-19 Infection

The Brugada-like ECG pattern is a transient condition which may be induced by number of conditions. In this case reported, a 53-year-old Iranian male patient, presented with 7-day history of fever, chills, headache and shortness of breath. At the time of presentation to the Emergency Department (ED), the patient was febrile with tachycardia, tachypnea, and oxygen (O2) saturation 75%. The chest radiograph showed a bilateral infiltration and positive result of Real Time Polymerase Chain Reaction (RT-PCR) confirmed the diagnosis of COVID-19 infection. He received Kaletra, Hydroxychloroquine, Azithromycin, Antibiotics, and Intravenous Immunoglobulin (IVIG). The patients was intubated and underwent mechanical ventilation because of no improvement on the O2 saturation level. Fever subsided on 7th day and Hydroxychloroquine was stopped on 5th day. On the sixth day of hospital stay, Electrocardiogram (ECG) showed sinus tachycardia. Troponin-I- high sensitive was within normal range and Transthoracic Echocardiography (TTE) showed normal Ejection Fraction (EF). On 10th day, type I Brugada ECG pattern presented and regular ECG monitoring was recommended. Finally, after eleven-day hospital stay, the patient died due to bradycardia and asystole despite Cardiopulmonary Resuscitation (CPR). Thus, physicians should consider Brugada ECG pattern in the precordial leads (V1 to V3) of ECG among patients with COVID-19 infection beside regular QT interval monitoring.

Brugada-Type Pattern on Electrocardiogram Associated with High-Dose Loperamide Abuse

BackgroundLoperamide has been increasing in popularity recently for its effects separate from treatment of diarrhea. In large doses or in combination with other agents, it can lead to desirable effects in the central nervous system. However, cardiotoxicity has been reported with its abuse. Case ReportA 49-year-old male who had been chronically abusing loperamide was found to have Brugada-like changes on his electrocardiogram (ECG). He had no other clinical symptoms associated with Brugada syndrome and did not have similar findings on previous ECGs. After abstaining from further loperamide use during hospitalization, this pattern slowly resolved without clinically significant dysrthymias. Why Should an Emergency Physician Be Aware of This?A patient with a history of loperamide abuse is at risk for cardiotoxicity. While other dysrhythmias are reported more commonly with loperamide abuse, Brugada-like ECG changes can occur and warrant appropriate consultation and prompt follow-up.

Screening high school students in Italy for sudden cardiac death prevention by using a telecardiology device: a retrospective observational study.

In 2010, an Italian project was launched aimed at using a telecardiology device in order to perform early diagnosis of young students at risk of sudden cardiac death. Our retrospective observational study was conducted on a population of 13,016 students, aged between 16 and 19 years, in different Italian regions. It consisted of analysis of data recorded during a telecardiology pilot study. The recorded data were electrocardiograms and data concerning lifestyle habits and family history of cardiovascular diseases. In total, 14 alterations in the electrocardiogram signal have been considered in this study. Some of these alterations are as follows: ventricular ectopic beats, atrioventricular block, Brugada-like electrocardiogram pattern, left anterior/posterior fascicular block, left/right ventricular hypertrophy, long/short QT interval, left atrial enlargement, right atrial enlargement, short PQ interval, and ventricular pre-excitation Wolff-Parkinson-White syndrome. On the basis of the collected data, we implemented this retrospective observational study. The analysed data showed that 13.60% of students had a family history for cardiovascular diseases, 22.43% reported smoking habits, 26.23% reported alcohol consumption, and 7.24% reported abuse of drugs. A total of 24% of students had at least one of the 14 electrocardiogram pathological alterations considered in our study and 32% had electrocardiogram values within the normal range. This retrospective observational study analysed data registered during our telecardiology activity. This activity permitted to maximise data collection and minimise the costs for collecting such data. This activity of screening is being continued and in the next few years it will allow us to have a greater mass of data.

A Brugada-like electrocardiogram pattern induced after radiofrequency catheter ablation of atrial fibrillation

A Brugada-like electrocardiogram pattern induced after radiofrequency catheter ablation of atrial fibrillation

Electrocardiographic specificities in athletes

The use of electrocardiogram in athletes as a routine screening method for diagnosing potentially dangerous cardiovascular diseases is still an issue of debate. According to the guidelines of the European Society of Cardiology, the recording of electrocardiogram is necessary in all athletes as a screening method, whereas the guidelines of the American Heart Association do not necessitate an electrocardiogram as a screening method and they insist on detailed personal and family history and clinical examination. CLASSIFICATION OF ELECTROCARDIOGRAM CHANGES IN ATHLETES: According to the classification of the European Society of Cardiology, electrocardiogram changes in athletes are divided into two groups: a) usual (physiological) that are connected with training; b) unusual (potentially clinically relevant) that are not connected with training. SUDDEN CARDIAC DEATH IN ATHLETES: The most frequent causes include hypertrophic cardiomyopathy and congenital coronary artery anomalies, while others may be found only sporadically at autopsy. Physiological electrocardiogram changes are frequent in asymptomatic athletes and they do not require further assessment. They include sinus bradycardia, atrioventricular blocks of I and II degree--Wenkebach, isolated increased QRS voltage, incomplete right bundle branch block and early repolarization. Potentially pathological electrocardiogram changes in athletes are not frequent but they are alarming and they urge further assessment to diagnose the underlying cardiovascular disease as well as the prevention of sudden cardiac death. They include: T wave inversion, ST segment depression, complete right or left bundle branch block, atrial pre-excitation syndrome-WPW, long QT interval, short QT interval, Brugada like electrocardiogram finding. Introduction of electrocardiogram recording into the screening protocol in athletes increases the sensitivity of evaluation and may help to discover asymptomatic cardiovascular diseases that may cause sudden cardiac death. Special attention and further assessment are required when the above potentially pathological electrocardiogram changes are found in athletes.

Unexplained syncope in a patient with Brugada-like electrocardiogram. Lighting the dark side of underlying bradyarrhythmias

Unexplained syncope in a patient with Brugada-like electrocardiogram. Lighting the dark side of underlying bradyarrhythmias

Concomitant Brugada-like and short QT electrocardiogram linked to SCN5A mutation

Mutations in the α-subunit of cardiac sodium channel gene SCN5A can lead to the overlapping phenotypes of both the Brugada and type 3 long QT syndromes. However, the combination of Brugada and a short QT phenotype resulting from mutation in SCN5A has not previously been described. A man with concomitant Brugada-like and short QT electrocardiogram (ECG) was identified and the SCN5A gene was sequenced. Whole-cell patch clamp analysis of human embryo kidney (HEK) 293 cells expressing a SCN5A channel with the patient's sequence was used to investigate the biophysical properties of the channel. The patient with the family history of sudden death showed Brugada-like and short QT interval ECG. Sequence analysis of the coding region of the SCN5A gene, identified a G to A heterozygous missense mutation at nucleotide site 2066 that resulted in a amino-acid substitution of arginine to histidine at amino-acid site 689 (R689H). Patch clamp analysis showed that the R689H failed to generate current when heterologously expressed in HEK293 cells, indicating it was a loss-of-function mutation. Our finding firstly shows that a heterozygous missense mutation R689H in SCN5A gene results in the loss of protein function and the coexistents of the Brugada-like and short QT interval ECG phenotypes.

Brugada-Type Electrocardiogram in the Taiwanese Population–Is it a Risk Factor for Sudden Death?

People receive electrocardiogram (ECG) examination for various reasons in a hospital setting. An important clinical practice issue may be that cardiologists need to be consulted for Brugada-type ECGs identified through routine screening. We investigated the prevalence and prognosis of patients with Brugada-type ECG in a hospital-based population in an attempt to improve the management of these patients. In 20,562 patients seeking medical care for non-cardiovascular reasons, 74,955 ECGs were performed from December 1999 to February 2001. The diagnostic criteria for Brugada-like ECG from the European Society of Cardiology were used. International Statistical Classification of Diseases codes and city residents' records were documented to indicate the reasons for visiting clinics or hospitalization and mortality outcome. Medical records were reviewed and telephone interviews were conducted. Twenty-six (0.13%) of the 20,562 patients were confirmed to have Brugada-type ECGs. None of these patients had ever experienced syncope, near syncope or sudden cardiac death. After 57.1 ± 15.8 months of follow-up, there were four deaths out of the 26 patients with Brugada-type ECG (15.4%, 95% CI: 1.53-2.9%) compared with 2899 of those without (14.1%, 95% CI: 13.6-14.5%; p=0.89, log-rank test). Neither sudden cardiac death (p=0.61) nor hospitalized death (p=0.55) was different between patients with and without Brugada-type ECG. Patients with Brugada-type ECGs are not rare in a hospital-based population. The presence of Brugada-type ECGs in patients without syncope or sudden cardiac death was not associated with hospitalized mortality.

Brugada-like electrocardiogram detected after reconstructive operation for oesophageal cancer

A 63-year-old male was admitted to our surgical department for an operation for oesophageal cancer. He had no episodes of syncope or a family history …

A case of vasospastic angina with Brugada-like electrocardiogram in coronary vasospasm test: A case report

A case of vasospastic angina with Brugada-like electrocardiogram in coronary vasospasm test: A case report

A case of Brugada-like electrocardiogram and following ventricular fibrillation caused by occlusion of conus branch artery

A case of Brugada-like electrocardiogram and following ventricular fibrillation caused by occlusion of conus branch artery

Brugada-like ECG pattern in a patient with isolated right ventricular infarction

A 55-year-old female patient collapsed at home with sudden cardiac death. Upon arrival of the emergency physician, the patient was defibrillated for ventricular fibrillation (VF). After successful mechanical resuscitation, the patient was transferred to our intensive care unit requiring high-dose vasopressor support. The electrocardiogram (ECG) at presentation showed atrial fibrillation with right bundle branch block and cove-type ST segment elevation in leads V1 and V2, ECG abnormalities suggestive of Brugada syndrome (Figure 1). Transthoracic echocardiography showed left ventricular hypertrophy and preserved systolic left ventricular function without significant wall motion abnormalities. Right ventricular function was, however, markedly reduced. Myoglobin at presentation was 1,287 mg/l with a creatine kinase of 134 U/l and a troponin I of 0.02 ng/ml. Because of the conspicuous ECG changes, Brugada syndrome was initially suspected and coronary angiography was delayed in order to stabilize the patient hemodynamically. During the next hours, the patient developed recurrent episodes of VF, which were refractory to amiodarone and could finally be prevented by transjugular venous pacing at 90 beats per minute. Laboratory analysis exhibited a significant rise in cardiac markers and the patient underwent coronary angiography. Coronary angiography revealed proximal thrombotic occlusion of a small nondominant right coronary artery (Figure 2a), which could be successfully recanalized (Figure 2b). Isolated right ventricular infarction is an extremely rare event. It has been associated with unusual ECG appearances which may be misinterpreted or even missed if not suspected. Ischemia of the right ventricular free wall to the outflow tract may cause ST segment elevations in leads V1–V3 similar to Brugada syndrome, as in the present case. Similar Brugada-like ECG pattern may also occur in hypothermic patients or patients that have undergone mechanical resuscitation. In the literature, there have been several case reports highlighting that Brugada syndrome can be mistaken for acute myocardial infarction. This case illustrates that the reverse may also occur. Address for Correspondence Dr. Holger Eggebrecht Department of Cardiology University of Duisburg-Essen Hufelandstrase 55 45122 Essen Germany Phone (+49/201) 723-3363, Fax -5931 e-mail: holger.eggebrecht@uk-essen.de 1 Department of Cardiology, West-German Heart Center Essen, University of Duisburg-Essen, Essen, Germany.

Men With Brugada-Like Electrocardiogram Have Higher Risk of Prostate Cancer

Elevated plasma testosterone levels are thought to play a role in the male preponderance of cases of Brugada syndrome (BS) and the development of prostate cancer. The 34 Brugada-like electrocardiogram (ECG) cases were identified among 2,681 male survivors of the atomic bomb who had undergone at least 1 biennial health examination between July 1958 and December 1999 in Nagasaki, Japan. They were followed for incident prostate cancer from July 1958 through December 2004, and the risk of prostate cancer for Brugada-like ECG, age, smoking habit, and radiation exposure was analyzed using Cox proportional hazards analysis. Among the men with or without Brugada-like ECG there were 4 (11.8%) and 54 (2.0%) cases of prostate cancer, respectively. With age adjustment there was a higher risk of prostate cancer for Brugada-like ECG (relative risk (RR): 5.42, 95% confidence interval (CI) 1.96-15.00, P=0.001). With further adjustment for smoking habit and radiation dose, Brugada-like ECG remained a significant risk factor for prostate cancer (RR: 6.47, 95%CI 1.97-21.21, P=0.002). Brugada-like ECG confers a higher risk of prostate cancer independent of age, smoking habit, and radiation exposure. Men with a Brugada-like ECG should be regularly examined for prostate cancer and vice versa, especially elderly subjects.

Hypothermia-induced Brugada-like electrocardiogram pattern

A patient in whom moderate hypothermia developed after prolonged cardiopulmonary resuscitation is described. Hypothermia was manifested by transient electrocardiogram changes, including long QT, precordial J waves, and downsloping ST-segment elevation ending in a negative T wave in leads V 1 and V 2 resembling the Brugada syndrome. The physiopathologic mechanisms of these electrocardiographic findings are discussed.

Spontaneous alternans in Brugada ST-segment morphology within minutes

Brugada syndrome is an inherited, life-threatening, cardiac channelopathy where the electrocardiogram (ECG) characteristically depicts a classic pattern of complete or incomplete right bundle-branch block with ST-segment elevation in the right precordial leads V 1 to V 3. These, almost inalienable, ECG patterns may be dynamic, where changes may resolve to baseline or one particular type may evolve into another. Such alternans has been described with fever, electrolyte imbalances, atrial pacing, glucose and/or insulin administration, psychotropic drugs, β-adrenergic blocker use, class IA and IC antiarrhythmic provocation testing, such as with ajmaline, procainamide, or flecainide, and even large meals, that is, “full stomach sign.” However, spontaneous alternans between the different types of Brugada ECG patterns (types) have not been reported within minutes, in the absence of previously described precipitating factors. We present a novel case where classic, type 2, Brugada-like ECG pattern evolved spontaneously to type 1 before returning to type 2 within minutes of presentation.

Brugada-like electrocardiogram pattern: how to stratify the risk for sudden cardiac death. Is sports activity contraindicated?

Brugada syndrome is associated with a considerable risk of sudden death in young and otherwise healthy adults. The syndrome is estimated to be responsible for at least 4% of all sudden deaths and at least 20% of sudden deaths in patients with structurally normal hearts. The diagnosis of Brugada syndrome is based on peculiar electrocardiogram (ECG) abnormalities classified by the European Society of Cardiology in three types: type 1 (coved-type) is the diagnostic pattern; type 2 (saddle-back type); and type 3 are considered significant if there is a conversion to a type 1, spontaneously or during administration of class I A/C anti-arrhythmic drugs (flecainide, etc.). There is a general agreement about the high risk of sudden death in patients with previous cardiac arrest, for whom an implantable defibrillator (ICD) is recommended. In contrast, controversy exists on the correct clinical behaviour in individuals without a history of previous cardiac arrest. To stratify the risk in patients with type 1 pattern, three major factors have been suggested: typical ECG pattern in the basal state; a history of syncope; and inducible ventricular tachycardia/ventricular fibrillation during electrophysiological study (EPS). However, the indication and usefulness of an EPS is debatable. In patients with a type 2 or 3 pattern a pharmacological test is indicated in the presence of symptoms or of a familial history. With regard to sports eligibility, patients with a history of cardiac arrest should have an ICD and they can practise (low intensity) sport only after the implant of the device. Patients without documented cardiac arrest but at high risk (basal type 1 ECG pattern, syncope and/or positive EPS) should also have an ICD and they can practise (low intensity) sport only after the implant of the device. In patients at low risk (type 1 ECG pattern in the absence of symptoms, without family history and negative EPS) the behaviour regarding sport eligibility is not a matter of debate. In cases with type 2 or 3 pattern, in the absence of familial history and symptoms, a permissive behaviour should be assumed.