IJCS | Volume 32, Nº1, January/ February 2019

DOI: 10.5935/2359-4802.20180079 91 CASE REPORT International Journal of Cardiovascular Sciences. 2019;32(1)91-94 Mailing Address: José Luis Costa Sena Martins Baixo Vouga Hospital Center - Avenida Doutor Artur Ravara, 3840. Postal Code: 3810-193, Aveiro - Portugal. E-mail: zeluismartins@gmail.com Brugada Pattern, Brugada Phenocopy, What to Think? José Luis Martin s, R aquel Ferreira, Jesus Viana, José Santos Centro Hospitalar Baixo Vouga, Aveiro - Portugal Manuscript received November 10, 2017; revised May 10, 2018; accepted June 06, 2018. Brugada syndrome/genetic; Propafenone; Anti- Arrhythmia Agents; Suicide; Death, Sudden, Cardiac; Arrhythmias, Cardiac; Electrocardiography. Keywords Introduction Propafenone is a class 1 anti-arrhythmic medication with beta-adrenergic and calcium channel blocker properties. B r u g a d a s y nd r ome ( B r S ) h a s a t y p i c a l electrocardiographic pattern characterized by increased propensity for malignant ventricular arrhythmias and sudden death in patients with no structural heart disease. 1 Brugada phenocopies (BrP) have electrocardiographic patterns that are identical to true type 1 and type 2 Br, despite the absence of a true congenital BrS. BrP are elicited by clinical conditions including ionic (or water and electrolyte) disturbances, myocardial ischemia and pulmonary embolism. 2-5 We report a case of suicide attempt by an overdose of propafenone which yielded a type 1 Brugada pattern. Case report Seventeen-year-old adolescent admitted to the emergency department for voluntary intake of 40 tablets of propafenone 150 mg. The patient was hemodynamically stable at admission and conscious. There was no known family history of cardiovascular diseases, syncope or arrhythmias. Gastric lavage followed by activated charcoal (50 g) was performed, with emptying of food, but apparently not of medication. Ten minutes after admission, the patient had a generalized tonic clonic-seizure (with intravenous administration of midazolam 5 mg), followed by severe bradycardia that progressed to cardiac and respiratory arrest. Advanced life support (ALS) measures were started with return of spontaneous circulation (ROSC) after the fourth cycle. Electrocardiography (ECG) was performed and revealed a wide QRS and ST segment elevation in V1-V2 leads, consistent with a BS pattern (Figure 1). Arterial-blood gas test showed: pH 7.08; PCO 2 : 51 mmHg; pO 2 45 mmHg; Na 145 mmol/L; K 3.6 mmol/L; Cl 113 mmol/L; Lact 9.4 mmol/L; HCO 3 14.8mmol/LA second cardiorespiratory arrest occurred 20 minutes after ROSC, followed by three cycles of ALS and ROSC. For hemodynamic and rhythm stabilization, a temporary pacemaker was implanted by right femoral artery access. Norepinephrine at 0.1 mcg/ kg/min and sodiumbicarbonate 8.4%were administered for recovery of pulse rate. Complete reversal of the signs of toxicity was observed three hours after hospital admission. ECG then revealed sinus rhythmwith no BrP features (Figure 2). Discussion BS is a rare, genetically determined condition with autosomal dominant transmission. 1 Today, the diagnosis of BS is defined by the presence of type 1 ECG in at least two right precordial leads, combined with one of the following: documented ventricular fibrillation (VF) or ventricular tachycardia (VT), family history of cardiac sudden death (< 45 years), type 1 ECG in other members of the family, VF/VT in programmed electrical stimulation or syncope. 6 Diagnosis may be difficult in cases of borderline or Brugada-like repolarization patterns with or without symptoms. 5 Recent studies have reported cases of type 1 Brugada pattern at ECG caused by underlying causes, with normalization of ECG. Theses cases were classified as type 1 Brugada pattern. 2-5 BrP have been classified by