278
Letters to the Editor
Brugada phenocopy or Brugada ECG pattern in patients characterized by early repolarization pattern and additional arrhythmogenic right ventricular cardiomyopathy Stefan Peters St. Elisabeth Hospital Salzgitter, Cardiology, Liebenhaller Str. 20, 38259 Salzgitter, Germany
a r t i c l e
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Article history: Received 5 December 2013 Accepted 30 December 2013 Available online 10 January 2014 Keywords: Brugada phenocopy Brugada ECG pattern Brugada syndrome
It can be discussed whether the term Brugada phenocopy or Brugada ECG pattern in my manuscript should be used. In my opinion, Brugada ECG pattern is the right term to be used if hyperkalemia, Curschmann–Steinert syndrome and pectus excavatum provoke coved-type ST segment elevation in right precordial leads. It is definitely not true that positive provocative challenge characterizes in all cases true congenital Brugada syndrome.
References I read with interest the comment of terminological clarification of Brugada phenocopy, Brugada Syndrome, and the Brugada ECG pattern published by Anselm [1]. In all patients described in my paper [2] ventricular arrhythmias were present. Family history was not systematically searched for. In patients with early repolarization pattern the diagnosis of additional arrhythmogenic right ventricular cardiomyopathy was settled. Coved-type ST segment elevation in right precordial leads was present by ajmaline testing possibly due to right ventricular outflow tract sodium channel dysfunction [3–5] not to be confused with true congenital Brugada syndrome. In a previously published paper [6] subtle structural abnormalities were found if provocable ST segment elevation in right precordial leads and early repolarization pattern were present.
0167-5273/$ – see front matter © 2014 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijcard.2013.12.241
[1] Anselm DD, Baranchuk A. Terminological clarification of Brugada phenocopy, Brugada syndrome, and Brugada ECG pattern. Int J Cardiol 2014;171:288. [2] Peters S. Early repolarization pattern in patients with provocable Brugada phenocopy: a marker of additional arrhythmogenic cardiomyopathy? Int J Cardiol 2013;168:4928–9. [3] Yan CX, Antzelevitch C. Cellular basis for the Brugada syndrome and other mechanisms of arrhythmogenesis associated with St-segment elevation. Circulation 1999;100:1660–6. [4] Meregalli PG, Wilde AA, Tan HL. Pathophysiological mechanisms of Brugada syndrome: depolarization disorder, repolarization disorder, or more? Cardiovasc Res 2005;15:367–78. [5] Boukens BJ, Sylva M, de Gier-de Vries C, et al. Reduced sodium channel function unmasks residual slow conduction in the adult right ventricular outflow tract. Circ Res 2013;113:137–41. [6] Bastiaenen R, Raju H, Sharma S, et al. Characterization of early repolarization during ajmaline provocation and exercise tolerance testing. Heart Rhythm 2013;10:247–54.
Letters to the Editor
Brugada phenocopy or Brugada ECG pattern in patients characterized by early repolarization pattern and additional arrhythmogenic right ventricular cardiomyopathy Stefan Peters St. Elisabeth Hospital Salzgitter, Cardiology, Liebenhaller Str. 20, 38259 Salzgitter, Germany
a r t i c l e
i n f o
Article history: Received 5 December 2013 Accepted 30 December 2013 Available online 10 January 2014 Keywords: Brugada phenocopy Brugada ECG pattern Brugada syndrome
It can be discussed whether the term Brugada phenocopy or Brugada ECG pattern in my manuscript should be used. In my opinion, Brugada ECG pattern is the right term to be used if hyperkalemia, Curschmann–Steinert syndrome and pectus excavatum provoke coved-type ST segment elevation in right precordial leads. It is definitely not true that positive provocative challenge characterizes in all cases true congenital Brugada syndrome.
References I read with interest the comment of terminological clarification of Brugada phenocopy, Brugada Syndrome, and the Brugada ECG pattern published by Anselm [1]. In all patients described in my paper [2] ventricular arrhythmias were present. Family history was not systematically searched for. In patients with early repolarization pattern the diagnosis of additional arrhythmogenic right ventricular cardiomyopathy was settled. Coved-type ST segment elevation in right precordial leads was present by ajmaline testing possibly due to right ventricular outflow tract sodium channel dysfunction [3–5] not to be confused with true congenital Brugada syndrome. In a previously published paper [6] subtle structural abnormalities were found if provocable ST segment elevation in right precordial leads and early repolarization pattern were present.
0167-5273/$ – see front matter © 2014 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijcard.2013.12.241
[1] Anselm DD, Baranchuk A. Terminological clarification of Brugada phenocopy, Brugada syndrome, and Brugada ECG pattern. Int J Cardiol 2014;171:288. [2] Peters S. Early repolarization pattern in patients with provocable Brugada phenocopy: a marker of additional arrhythmogenic cardiomyopathy? Int J Cardiol 2013;168:4928–9. [3] Yan CX, Antzelevitch C. Cellular basis for the Brugada syndrome and other mechanisms of arrhythmogenesis associated with St-segment elevation. Circulation 1999;100:1660–6. [4] Meregalli PG, Wilde AA, Tan HL. Pathophysiological mechanisms of Brugada syndrome: depolarization disorder, repolarization disorder, or more? Cardiovasc Res 2005;15:367–78. [5] Boukens BJ, Sylva M, de Gier-de Vries C, et al. Reduced sodium channel function unmasks residual slow conduction in the adult right ventricular outflow tract. Circ Res 2013;113:137–41. [6] Bastiaenen R, Raju H, Sharma S, et al. Characterization of early repolarization during ajmaline provocation and exercise tolerance testing. Heart Rhythm 2013;10:247–54.
