Brugada phenocopy: A new electrocardiogram phenomenon

Table 1 Brugada phenocopy etiological categories

Etiological category
Metabolic conditions
Mechanical compression
Ischemia and pulmonary embolism
Myocardial and pericardial disease
ECG modulation
Miscellaneous

Reproduced with permission[9]. ECG: Electrocardiogram.

Table 2 Criteria to differentiate the Brugada electrocardiogram pattern, Brugada phenocopy and true congenital Brugada syndrome

Brugada ECG pattern

The ECG pattern has a type 1 or type 2 Brugada morphology as currently defined by Bayés de Luna et al[1]

Diagnostic criteria for BrP

The ECG pattern has a type 1 or type 2 Brugada morphology

The patient has an underlying condition that is identifiable

The ECG pattern resolves after resolution of the underlying condition

There is a low clinical pretest probability of true BrS determined by lack of symptoms, medical history and family history

Negative provocative testing with sodium channel blockers such as ajmaline, flecainide or procainamide

Provocative testing not mandatory if surgical RVOT manipulation has occurred within the last 96 h

The results of genetic testing are negative (desirable but not mandatory because the SCN5A mutation is identified in only 20% to 30% of probands affected by true BrS)

Features that suggest true congenital BrS

The ECG pattern has a type 1 or type 2 Brugada morphology

There is a high clinical pretest probability of true congenital BrS determined by presence of symptoms, medical history and family history

Positive provocative testing with sodium channel blockers such as ajmaline, flecainide or procainamide. This indicates sodium channel dysfunction consistent with true BrS

Genetic testing is positive in about 20% to 30% of probands

Reproduced with permission[16]. RVOT: Right ventricular outflow tract; SCN5A: Sodium channel voltage-gated type V alpha subunit; BrP: Brugada phenocopies; BrS: Brugada syndrome.