Hypothermia-induced Brugada-like electrocardiogram pattern
Introduction
Although hypothermia has been listed as a cause of Brugada-like electrocardiogram (ECG) pattern,1, 2 clinical cases of right precordial ST-segment elevation mimicking Brugada syndrome (BrS) have rarely been reported in the hypothermia setting.3, 4 We report a patient with moderate hypothermia who developed a transient Brugada sign characterized by precordial J waves and coved ST-segment elevation ending in a negative T wave in leads V1 and V2.
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Case report
A 78-year-old man with chronic obstructive pulmonary disease was hospitalized after prolonged bystander resuscitative effort for gasping. His relatives denied any previous history of malignant arrhythmias, syncope, or family episodes of sudden death. His family members did not show any ECG pattern of BrS. On admission, the patient was unconscious, bradycardic, bradypneic, and hypothermic. There was also subcutaneous emphysema and absence of left breath sound due to left tension pneumothorax. He
Discussion
The BrS is characterized by a right precordial ST-segment elevation and a high incidence of sudden death in patients with structural normal heart (ion channel cardiomyopathy).1, 5, 6, 7 Although 3 ECG repolarization patterns in the right precordial leads are recognized, only the type 1 (coved ST-segment elevation ≥2 mm and inverted T wave) is diagnostic of BrS. This pattern can be observed spontaneously or after the administration of sodium channel blocks. Although hypothermia can produce J
References (19)
Acquired forms of the Brugada syndrome
J Electrocardiol
(2005)- et al.
Profound hypothermia mimicking a Brugada type ECG
J Electrocardiol
(2003) - et al.
Electrocardiogram interpretation and class I blocker challenge in Brugada syndrome
J Electrocardiol
(2006) - et al.
Diagnosis and genetic aspects of the Brugada and other inherited arrhythmias syndromes
J Electrocardiol
(2007) Electrocardiographic issues related to action potential phases 1 and 2 on the occasion of a case of accidental mild hypothermia
Int J Cardiol
(2001)- et al.
Electrocardiographic manifestations of hypothermia
Am J Emerg Med
(2002) - et al.
Images in resuscitation: the ECG in hypothermia
Resuscitation
(2005) - et al.
Lethal ECG changes hidden by therapeutic hypothermia
Lancet
(2007) - et al.
The influence of cardiopulmonary resuscitation without defibrillation on serum levels of cardiac enzymes: a time course study of out-of-hospital cardiac arrest survivors
Resuscitation
(2006)
Cited by (13)
Specific Brugada Phenocopies: Electrolyte and Metabolic Disorders
2018, Brugada Phenocopy: The Art of Recognizing the Brugada ECG PatternGenetic, Ionic, and Cellular Mechanisms Underlying the J Wave Syndromes
2018, Cardiac Electrophysiology: From Cell to Bedside: Seventh EditionInduced Brugada syndrome: Possible sources of arrhythmogenesis
2017, Revista Portuguesa de CardiologiaCitation Excerpt :Similarly to fever, hypothermia may also induce or accentuate J waves, probably by slowing activation of ICa, leaving Ito unopposed5. However, it seems more likely to provoke Brugada-like ECG abnormalities, mimicking an actual BrS5,38,39. Moreover, the development of arrhythmias in BrS appears to be promoted only by fever, unlike early repolarization syndrome, in which hypothermia appears to induce VA5.
Triggers for arrhythmogenesis in the Brugada and long QT 3 syndromes
2016, Progress in Biophysics and Molecular BiologyCitation Excerpt :Under extreme hypothermia or hyperthermia core body temperature may go below 35 °C or rise to 45 °C, respectively (Suchard, 2007; Tokutomi et al., 2009). Case studies show that the effects of hyperthermia or hypothermia on BrS are varied, potentially due to different environmental or genetic factors (Kum et al., 2002; Ortega-Carnicer et al., 2008; Porres et al., 2002). Many case studies show hyperthermia has detrimental effects on asymptomatic BrS patients causing the BrS patterns to be unmasked under febrile conditions and remain unmasked upon restoration of core body temperature (De Marco et al., 2012; Dumaine et al., 1999; Ozeke et al., 2005).
Brugada syndrome in a patient with syncope. A case report and literature review
2010, Revista Colombiana de CardiologiaOsborn waves during therapeutic hypothermia and recurrence of fatal arrhythmia in patients resuscitated following sudden cardiac arrest
2020, PACE - Pacing and Clinical Electrophysiology