Suspected Brugada Phenocopy Secondary to Coronary Slow Flow

Area of Science:

• Cardiology
• Electrophysiology
• Medical Diagnostics

Background:

• Brugada syndrome (BrS) is a genetic disorder associated with increased risk of ventricular arrhythmias and sudden cardiac death (SCD) in individuals with structurally normal hearts.
• Brugada phenocopy (BrP) describes an electrocardiographic pattern similar to BrS, but without the underlying genetic syndrome.
• Various factors can cause BrP, but its association with coronary slow flow (CSF) has not been previously documented.

Observation:

• This case report details a patient presenting with a Brugada type 1 electrocardiographic pattern.
• The electrocardiographic findings were suspected to be associated with the coronary slow flow (CSF) phenomenon.
• The Brugada type 1 pattern observed in the patient normalized after receiving guideline-directed medical therapy for acute coronary syndrome.

Findings:

• A novel association between coronary slow flow (CSF) and the Brugada type 1 electrocardiographic pattern (a form of Brugada phenocopy) is reported.
• The Brugada electrocardiographic pattern resolved following treatment for acute coronary syndrome, indicating a potential reversible cause.

Implications:

• This finding suggests that coronary slow flow may be an underrecognized cause of Brugada phenocopy.
• Identifying and treating underlying conditions like acute coronary syndrome can potentially reverse Brugada electrocardiographic abnormalities.
• This highlights the importance of considering coronary artery disease in the differential diagnosis of Brugada phenocopy.