Brugada phenocopy secondary to extensive inferior wall ischemia induced by coronary steal effect

The diagnosis of Brugada syndrome is usually made with a typical ECG pattern. However, different disorders can emulate this pattern (Brugada phenocopies). Pathophysiologic mechanisms underlying this phenomenon remain controversial. We describe the development of type-1 Brugada ECG pattern associated with extensive coronary steal effect during myocardial perfusion scintigraphy. Proximal occlusion of the right coronary artery and severe proximal stenosis in distally occluded left circumflex artery were confirmed by coronary angiogram. Brugada ECG pattern can be a reversible sign associated with inferior left ventricular and right ventricular ischemia. Its presence during acute ischemia deserves appropriate risk stratification.