Type 1 Brugada pattern electrocardiogram induced by hypokalemia

Area of Science:

• Cardiology
• Electrophysiology
• Genetics

Background:

• Brugada syndrome is an inherited arrhythmogenic ion channel disease characterized by coved-type ST-segment elevation in right precordial leads.
• It can lead to ventricular arrhythmias and sudden cardiac death (SCD).
• The association between hypokalemia and the Brugada electrocardiogram (EKG) pattern is rarely reported.

Observation:

• A patient presented with hypokalemia (serum potassium 2.9 mmol/L).
• This was associated with a new right bundle branch block pattern and coved ST-segment elevations with inverted T waves in leads V1-V2, indicative of a Type 1 Brugada EKG pattern.
• The patient's serum potassium was corrected.

Findings:

• Repeated EKG 6 hours after potassium correction revealed the disappearance of the Type 1 Brugada pattern.
• Hypokalemia may unmask a Type 1 Brugada EKG pattern, although no specific serum potassium level is definitively known to induce it.

Implications:

• Physicians should be aware that hypokalemia can unmask Brugada syndrome.
• Patients with a family history of arrhythmia or SCD are at high risk.
• Monitoring electrolytes is crucial in patients with suspected or known Brugada syndrome, especially when presenting with EKG abnormalities.