Umut Kocabaş

High prevalence of concealed Brugada syndrome in patients with atrioventricular nodal reentrant tachycardia

BACKGROUND Atrioventricular nodal reentrant tachycardia (AVNRT) may coexist with Brugada syndrome (BrS). OBJECTIVES The present study was designed to determine the prevalence of drug-induced type 1 Brugada ECG pattern (concealed BrS) in patients presenting with clinical spontaneous AVNRT and to investigate their electrocardiographic, electrophysiological, and genetic characteristics. METHODS Ninety-six consecutive patients without any sign of BrS on baseline electrocardiogram undergoing electrophysiological study and ablation for symptomatic, drug-resistant AVNRT and 66 control subjects underwent an ajmaline challenge to unmask BrS. Genetic screening was performed in 17 patients displaying both AVNRT and BrS. RESULTS A concealed BrS electrocardiogram was uncovered in 26 of 96 patients with AVNRT (27.1%) and in 3 of 66 control subjects (4.5%) (P ≤ .001). Patients with concealed BrS were predominantly female patients (n=23 [88.5%] vs n=44 [62.9%], P = .015), had higher prevalence of chest pain (n=10 [38.5%] vs n=13 [18.6%], p=0.042), migraine headaches (n=10 [38.5%] vs n=10 [14.2%], p=0.008), and drug-induced initiation and/or worsening of duration and/or frequency of AVNRT (n=4 [15.4%] vs n=1 [1.4%], p=0.006) as compared to patients with AVNRT without BrS. Genetic screening identified 19 mutations or rare variants in 13 genes in 13 of 17 patients with both AVNRT and BrS (yield = 76.5%). Ten of these 13 genotype-positive patients (76.9%) harbored genetic variants known or suspected to cause a loss of function of cardiac sodium channel current (SCN5A, SCN10A, SCN1B, GPD1L, PKP2, and HEY2). CONCLUSION Our results suggest that spontaneous AVNRT and concealed BrS co-occur, particularly in female patients, and that genetic variants that reduce sodium channel current may provide a mechanistic link between AVNRT and BrS and predispose to expression of both phenotypes.

Brugada syndrome, Brugada phenocopy or none?

Brugada syndrome is a form of inherited arrhythmia syndrome characterized by a distinct ST‐segment elevation in the right precordial leads. Brugada phenocopies are clinical entities that present with an electrocardiographic pattern identical to Brugada syndrome and may obey to various clinical conditions. We present a case of a suicidal attempt using a high dose of propafenone causing a Brugada‐type electrocardiographic pattern. Is this a Brugada syndrome case, a Brugada phenocopy or something else?

A complicated trilogy: persistent left superior vena cava with hypertrophic cardiomyopathy and atrial septal defect

Extract: A 28-year-old asymptomatic woman was referred to ourclinic for evaluation of a heart murmur. Transthoracic echocardiography (TTE) demonstrated ventricular hypertrophy with septal thickness of 26 mm., consistent with hypertrophic cardiomyopathy (HCM). The diagnosis of HCM was confirmed by contrast-enhanced magnetic resonance imaging, and late gadolinium enhancement was observed in the anterior wall ...

Coexistence of atrioventricular accessory pathways and drug-induced type 1 Brugada pattern

Atrial arrhythmias, particularly atrioventricular nodal reentrant tachycardia, can coexist with drug‐induced type 1 Brugada electrocardiogram (ECG) pattern (DI‐Type1‐BrP). The present study was designed to determine the prevalence of DI‐Type1‐BrP in patients with atrioventricular accessory pathways (AV‐APs) and to investigate the clinical, electrocardiographic, electrophysiologic, and genetic characteristics of these patients.

Not All Brugada Electrocardiogram Patterns are Brugada Syndrome or Brugada Phenocopy

Address for Correspondence: Dr. Grace Xu, Department of Medicine, Queen’s University School of Medicine, Kingston, Canada Phone: 647 234 6926 e-mail: 15gjx@queensu.ca Received: 31 May 2017 Accepted: 15 September 2017 • DOI: 10.4274/balkanmedj.2017.0621 Available at www.balkanmedicaljournal.org Cite this article as: Xu G, Gottschalk BH, Kocabaş U, Baranchuk A. Not All Brugada Electrocardiogram Patterns are Brugada Syndrome or Brugada Phenocopy. Balkan Med J 2017;34:593 ©Copyright 2017 by Trakya University Faculty of Medicine / The Balkan Medical Journal published by Galenos Publishing House. Not All Brugada Electrocardiogram Patterns are Brugada Syndrome or Brugada Phenocopy