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Vol. 66. Issue 9.
Pages 756 (September 2013)
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Vol. 66. Issue 9.
Pages 756 (September 2013)
Letter to the Editor
DOI: 10.1016/j.rec.2013.05.003
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Brugada Phenocopy Emerging as a New Concept. Response
Fenocopia de Brugada: surgimiento de un nuevo concepto. Respuesta
Lluis Recasens, Oona Meroño??
Corresponding author

Corresponding author:
, Victor Bazan, Nuria Ribas
Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
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Rev Esp Cardiol. 2013;66:75510.1016/j.rec.2013.04.010
Daniel D. Anselm, Adrian Baranchuk
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To the Editor,

The authors appreciate the interest in the case report we published in Revista Española de Cardiología concerning the observation of the Brugada electrocardiographic (ECG) pattern in a patient with hyperkalemia.1 We likewise welcome the introduction of the concept of phenocopy, an expression with which our finding is compatible.2,3 We also consider it opportune to stress that both the latest consensus on ECG diagnosis of Brugada syndrome and the introduction of the term phenocopy are more recent than the online publication of our case report in 2011.2–4 The definitions of the ECG patterns that are typical of Brugada syndrome and those that mimic this syndrome in the presence of serum electrolyte disturbances were introduced subsequent to our publication.

It is important to highlight reasons for attributing the changes observed in the ECG to hyperkalemia rather than to the acidosis and hyponatremia also observed in our patient. Reports of Brugada phenocopy associated with hyponatremia and acidosis have described the development of pseudo J waves in the QRS complex and ST segment depression in leads other than right precordial leads. These are precisely the features that differentiate this ECG pattern from type 1 Brugada pattern.5,6 Other possible causes (hyperglycemia, drugs, fever, and myocardial ischemia) were ruled out in the case discussed in our report.

We appreciate any contribution that aids in the understanding of the mechanisms involved in the induction of ECG patterns mimicking Brugada syndrome (phenocopies) and other patterns, such as early repolarization, which can also be associated with the risk of sudden cardiac death.7

Finally, we agree with Dr. Anselm on the importance of performing a challenge test with flecainide to rule out Brugada syndrome. Until the prognosis of patients presenting with Brugada phenocopy has been established, it is advisable to perform pharmacological challenge tests and, if appropriate, to induce ventricular arrhythmias by means of an electrophysiological study.

L. Recasens, O. Meroño, N. Ribas.
Hiperpotasemia simulando un síndrome de Brugada.
Rev Esp Cardiol, 66 (2013), pp. 309
A. Baranchuk, T. Nguyen, M.H. Ryu, F. Femenía, W. Zareba, A.A. Wilde, et al.
Brugada phenocopy: new terminology and proposed classification.
Ann Noninvasive Elecrocardiol, 17 (2012), pp. 299-314
D.D. Anselm, A. Baranchuk.
Brugada phenocopy: redefinition and updated classification.
Am J Cardiol, 111 (2013), pp. 453
A. Bayés de Luna, J. Brugada, A. Baranchuk, M. Borggrefe, G. Breithardt, D. Goldwasser, et al.
Current electrocardiographic criteria for diagnosis of Brugada pattern: a consensus report.
J Electrocardiol, 45 (2012), pp. 433-442
A. Tamene, S. Sattiraju, K. Wang, D.G. Benditt.
Brugada-like electrocardiography pattern induced by severe hyponatremia.
Europace, 12 (2010), pp. 905-907
J.C. Kovacic, D.L. Kuchar.
Brugada pattern electrocardiographic changes associated with profound electrolyte disturbance.
Pacing Clin Electrophysiol, 27 (2004), pp. 1020-1023
M.J. Junttila, S.J. Sager, J.T. Tikkanen, O. Anttonen, H.V. Huikuri, R.J. Myerburg.
Clinical significance of variants of J-points and J-waves: early repolarization patterns and risk.
Eur Heart J, 22 (2012), pp. 2639-2643
Copyright © 2013. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

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