ArticleJournal of the American Heart Association2019
Clinical Characteristics and Electrophysiological Mechanisms Underlying Brugada ECG in Patients With Severe Hyperkalemia.
Article in Journal of the American Heart Association, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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18 citing papers in PubMed, 29 citations in OpenAlex.
- Brugada Phenocopies: A Review of Mechanisms, Clinical Implications and Prognostic Considerations.Arrhythmia & electrophysiology review · 2026Review
- A Comprehensive Review of a Mechanism-Based Ventricular Electrical Storm Management.Journal of clinical medicine · 2025Review
- Hyperkalemia-induced Brugada phenocopy: a systematic review of case reports.Clinical research in cardiology : official journal of the German Cardiac Society · 2025Review
- Brugada Phenocopy due to Hyponatremia: A Case Report and Review of the Literature.The Journal of innovations in cardiac rhythm management · 2025Article
- A concealed arrhythmia: Brugada phenocopy as a cardiac manifestation of hyperkalaemia in diabetic ketoacidosis.The British journal of cardiology · 2025Article
- Brugada Phenocopy in a Critical Obstetric Patient: A Case Report.Case reports in medicine · 2025Article
- Machine learning models for early prediction of potassium lowering effectiveness and adverse events in patients with hyperkalemia.Scientific reports · 2024Article
- Use, misuse, and pitfalls of the drug challenge test in the diagnosis of the Brugada syndrome.European heart journal · 2023Review
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- Cardiovascular Diseases in the Digital Health Era: A Translational Approach from the Lab to the Clinic.Biotech (Basel (Switzerland)) · 2022Review
- Brugada Pattern Manifesting During Hyperkalemia, Diabetic Ketoacidosis, and Acute Alcohol Intoxication.The American journal of case reports · 2021Article
- The conduction velocity-potassium relationship in the heart is modulated by sodium and calcium.Pflugers Archiv : European journal of physiology · 2021Article
- Hyperkalemia induced Brugada phenocopy.Journal of arrhythmia · 2021Article
- Artificial Intelligence-Driven Algorithm for Drug Effect Prediction on Atrial Fibrillation: AnFrontiers in physiology · 2021Article
- Brugada Syndrome: Warning of a Systemic Condition?Frontiers in cardiovascular medicine · 2021Review
- Pathophysiology of Hyperkalemia Presenting as Brugada Pattern on Electrocardiogram (ECG).The American journal of case reports · 2020Article
- Clinical Characteristics and Electrophysiological Mechanisms Underlying Brugada ECG in Patients With Severe Hyperkalemia.Journal of the American Heart Association · 2019Article
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Authors and funding
13 authors at 6 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background Several metabolic conditions can cause the Brugada ECG pattern, also called Brugada phenotype (BrPh). We aimed to define the clinical characteristics and outcome of BrPh patients and elucidate the mechanisms underlying BrPh attributed to hyperkalemia. Methods and Results We prospectively identified patients hospitalized with severe hyperkalemia and ECG diagnosis of BrPh and compared their clinical characteristics and outcome with patients with hyperkalemia but no BrPh ECG. Computer simulations investigated the roles of extracellular potassium increase, fibrosis at the right ventricular outflow tract, and epicardial/endocardial gradients in transient outward current. Over a 6-year period, 15 patients presented severe hyperkalemia with BrPh ECG that was transient and disappeared after normalization of their serum potassium. Most patients were admitted because of various severe medical conditions causing hyperkalemia. Six (40%) patients presented malignant arrhythmias and 6 died during admission. Multiple logistic regression analysis revealed that higher serum potassium levels (odds ratio, 15.8; 95% CI, 3.1-79; P=0.001) and male sex (odds ratio, 17; 95% CI, 1.05-286; P=0.045) were risk factors for developing BrPh ECG in patients with severe hyperkalemia. In simulations, hyperkalemia yielded BrPh by promoting delayed and heterogeneous right ventricular outflow tract activation attributed to elevation of resting potential, reduced availability of inward sodium channel conductance, and increased right ventricular outflow tract fibrosis. An elevated transient outward current gradient contributed to, but was not essential for, the BrPh phenotype. Conclusions In patients with severe hyperkalemia, a BrPh ECG is associated with malignant arrhythmias and all-cause mortality secondary to resting potential depolarization, reduced sodium current availability, and fibrosis at the right ventricular outflow tract.
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