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Immune Checkpoint Inhibitor Myocarditis Masquerading as Brugada Syndrome
Aleksandr Talishinsky1, Kinan Bachour2, Charlie Lin2
1Department of Medicine, University of California at Los Angeles (UCLA), Los Angeles, California, USA.
Background:
Immune checkpoint inhibitor (ICI)-associated myocarditis is a rare but severe complication of novel cancer immunotherapies. Here, we present the first known case of Brugada electrocardiographic (ECG) phenocopy in the setting of ICI-associated myocarditis.
Case Summary:
A 67-year-old man presented with chest pain and syncope 5 weeks after his first dose of pembrolizumab for lung adenocarcinoma. Troponin biomarkers were elevated, cardiac magnetic resonance was consistent with myocarditis, and serial electrocardiograms showed dynamic ST-segment changes with intermittent type 2 Brugada pattern. Coronary angiography revealed nonobstructive coronary artery disease. His myocarditis and Brugada pattern resolved with prompt treatment. Further electrophysiology and genetic testing were negative for Brugada syndrome.
Discussion:
This case highlights the importance of early diagnosis and treatment of ICI-associated myocarditis, and the need for further research to elucidate the mechanisms, risk factors, and prognostic significance of associated ECG changes. We discuss management strategies for Brugada phenocopy in ICI-associated myocarditis and implications for cardio-oncology and electrophysiology practice.
Take-Home Messages:
ICI-associated myocarditis can present with type 2 Brugada ECG phenocopy. Early diagnosis and guideline-directed treatment of ICI-associated myocarditis are essential.
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