Type I Brugada-Like Pattern with Arrhythmia in Severe Anemia

Area of Science:

• Cardiology
• Genetics
• Internal Medicine

Background:

• Brugada syndrome (BrS) is an inherited cardiac disorder linked to gene mutations, a significant cause of sudden cardiac death.
• Brugada phenocopy presents an electrocardiographic pattern similar to BrS but arises from potentially reversible causes like metabolic disorders.
• Recognizing phenocopy is vital to prevent unnecessary interventions like implantable cardioverter-defibrillators.

Observation:

• A rare case of Brugada phenocopy is presented in a 60-year-old Indonesian male with severe anemia secondary to chronic bleeding.
• The patient's condition was associated with hypocalcemia during blood transfusion, precipitating temporary arrhythmia.
• Iron deficiency anemia can lead to myocardial ischemia and calcium channel degradation, contributing to cardiac channel dysfunction.

Findings:

• Brugada phenocopy can be precipitated by metabolic derangements, specifically hypocalcemia in the context of severe anemia.
• The arrhythmia observed was of right ventricular outflow tract origin and resolved after correcting hypocalcemia.
• This case highlights the link between anemia, ion channel dysfunction, and reversible cardiac arrhythmias.

Implications:

• Understanding the pathogenesis of Brugada phenocopy, particularly its association with metabolic conditions, is essential for accurate diagnosis and management.
• Early identification of Brugada phenocopy allows for targeted treatment of the underlying cause, improving patient outcomes.
• Distinguishing phenocopy from inherited Brugada syndrome is critical to avoid invasive procedures and guide appropriate therapy.