Possible Brugada Phenocopy Induced by Hypokalemia in a Patient with Congenital Hypokalemic Periodic Paralysis
Bibliographic record
Abstract
5. Anselm DD, Baranchuk A. Brugada Phenocopy Emerging as a New Concept. Rev Esp Cardiol. 2013;66(9):755. References DOI: 10.5935/abc.20130249 Dear Editor, We read with great interest the case report by Gazzoni et al1 regarding a Brugada ECG pattern induced by hypokalemia. This paper is important because it contributes to the growing body of literature describing Brugada Phenocopies (BrP)2-5. Briefly, BrP are characterized by ECG patterns that are identical to type-1 or type-2 Brugada ECG patterns despite the absence of true congenital Brugada Syndrome (BrS). BrP are induced by various clinical circumstances including: hypokalemia, hyperkalemia, hypothermia, myocardial ischemia, and pulmonary embolism. We have established six etiological categories of BrP2-4 along with a systematic approach to diagnose BrP3 by excluding sodium channel dysfunction in the myocardium. The presented case by Gazzoni et al1 would possibly qualify under category (i) metabolic conditions; however, further analysis of this case report is required. Specifically, this is the first report of a possible BrP induced by hypokalemia in association with hypokalemic periodic paralysis (HPP). Patients with HPP are known to have gene mutations resulting in abnormalities of either dihydropyridine-sensitive calcium channels or sodium channels (SCN4A) in skeletal muscles. Patients with true congenital BrS have mutations in the myocardial sodium channels (SCN5A) and the association in this patient is most intriguing and remains speculative. The type-1 “coved” Brugada ECG pattern observed in this patient could have been induced by the transient serum hypokalemia (which would qualify this as a BrP) or there may be a congenital dysfunction in this patient’s sodium channels in both his skeletal muscles (HPP) and myocardium resulting in the ECG abnormalities. Therefore, we recommend to the authors that a myocardial provocative challenge with a sodium channel blocker such as procainamide, ajmaline, or flecainide be performed to rule out myocardial sodium channel dysfunction. In addition, we also suggest that future reports use the established term Brugada Phenocopy to provide consistency in the literature and facilitate future research.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.006 | 0.005 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".