3 e-Letters

  • Brugada Phenocopy or unmasked Brugada Syndrome: Does observation without therapy is sufficient?

    Dear Editor,
    Cardiac death in patients with Brugada ECG changes and negative family history is still a debatable subject. Brugada Phenocopy (BrP) is an emerging phenomenon describing conditions inducing a Brugada-like electrocardiogram (ECG) manifestations in patients without true BS. Brugada Phenocopy is defined as ECG patterns suggestive of Brugada syndrome but developed secondary to various acquired etiologies other than congenital or genetic causes. BrP cases were reported secondary to electrolyte disturbances, myocardial infarction, acidosis, pulmonary embolism, electrocution injury etc. The pattern presents in relationship with an identifiable condition and normalizes upon resolution of the same. The number of BrP cases are steadily increasing and the number of conditions known to cause Brugada Phenocopy are also growing. The diagnostic criteria for Brugada Phenocopy are (1)
    I. An ECG Pattern that has a type -1 or type-2 Brugada morphology
    II. The patient has an indentifiable underlying condition.
    III. The ECG pattern resolves upon resolution of the underlying condition
    IV. The clinical pretest probability of true Brugada syndrome is low as determined by a lack of symptoms, medical history, and family history
    V. The results of provocative testing with a sodium channel blocker such as ajmaline, flecainide, or procainamide are negative
    VI. Provocative testing is not mandatory if surgical RVOT manipulation has...

    Show More
  • Tiger Stripes - a frequency artefact
    Danish H. Kazmi

    Band like signal artefacts on spectral doppler may additionally be noticed in other pathological conditions as in a Perimembranous VSD restricted by septal leaflet of tricuspid valve when the valve tissue oscillates within the VSD jet. Non pathological condition like sound of a crying child while being interrogated with spectral doppler interferes with fundamental frequency of the intracardiac doppler signal and thus of...

    Show More
  • Unusual data with missing of some influencing variables
    Rajeev Gupta

    Dear Editor,

    I read with interest the interesting paper. Few points worth sharing: 1.11.6 % in-hospital mortality is rather unusual, usually it is around 5% in the contemporary practice. 2. 55.6% patients had cardiogenic shock with STEMI at admission is highly unusual. May be highly selected population, leading to selection bias. Usually 2-4 % patients with STEMI presents with true cardiogenic shock ( not impend...

    Show More