Brugada Pattern in Diabetic Ketoacidosis: A Case Report and Scoping Study

Area of Science:

• Cardiology
• Electrophysiology
• Endocrinology

Background:

• Brugada syndrome is a rare cardiac arrhythmia characterized by RBBB and ST-segment elevation.
• SCNA5 mutations are the most common genetic cause, but non-genetic factors can also induce Brugada pattern.
• Previous reports link Brugada pattern to diabetic ketoacidosis (DKA), but isolated cases are common.

Purpose of the Study:

• To present a case of type 1 Brugada pattern in a young male with DKA.
• To explore the association between DKA, acidosis, electrolyte abnormalities, and Brugada pattern.
• To investigate the reproducibility of Brugada pattern in DKA during electrophysiology studies.

Main Methods:

• Case report of a 23-year-old male presenting with DKA and type 1 Brugada pattern.
• Analysis of potential mechanisms linking DKA to Brugada pattern, including acidosis and hyperkalemia.
• Review of existing literature and a scoping study on Brugada pattern in DKA.
• Assessment of Brugada pattern reproducibility during procainamide induction cardiac electrophysiology study (EPS).

Main Results:

• The patient presented with type 1 Brugada pattern during DKA, which resolved upon DKA treatment.
• DKA-induced Brugada pattern is attributed to acidosis and electrolyte disturbances affecting cardiac ion channels.
• Brugada pattern in DKA was not reproducible during procainamide-induced EPS.
• A scoping study revealed male predominance (20/22 cases) in Brugada pattern associated with DKA.

Conclusions:

• DKA can transiently induce a type 1 Brugada pattern, primarily due to metabolic derangements.
• This Brugada pattern is reversible with DKA management and typically does not manifest during electrophysiology studies.
• Male patients appear to be more susceptible to developing Brugada pattern in the context of DKA.