We read the recent Readers’ Comment by García-Niebla et al demonstrating that applying a nonstandard high-pass filter of 0.5 Hz can artificially distort the ST-segment and terminal portion of the T wave, resulting in Brugada type 2 morphology in the right precordial leads. The presented patient was a 55-year-old woman receiving an angiotensin II receptor antagonist for hypertension. No comment was made with regard to known structural heart disease. It seems possible that artificial (or inadvertent) modulation of the electrocardiographic (ECG) high-pass filter can reproduce the Brugada ECG pattern. This adds 1 additional category to our recent extensive review of Brugada phenocopies, in which we categorized them according to their pathogenesis. As such, we provide an update of the current Brugada phenocopy categories with the inclusion of the appropriate ECG high-pass filter ( Table 1 ).
| Category | Number of Patients (Number of Case Reports) | Age (years), Mean (Range) | Men/Women | ECG Type | Presence of Structural Heart Disease |
|---|---|---|---|---|---|
| Metabolic conditions | 14 (14) | 51.9 ± 17.8 (28–89) | 13/1 | 13 type 1, 5 type 2, 4 variable | 0 yes, 14 no |
| Mechanical Compression | 6 (5) | 45.7 ± 18.5 (19–66) | 3/3 | 6 type 1, 0 type 2, 0 variable | 3 yes, 3 no |
| Ischemia | 4 (4) | 60.0 ± 6.7 (55–68) | 2/2 | 4 type 1, 1 type 2, 1 variable | 1 yes, 3 no |
| Myocardial and pericardial disease | 8 (6) | 46.2 ± 13.9 (28–72) | 5/3 | 5 type 1, 4 type 2, 2 variable | 2 yes, 6 no |
| ECG modulation † | 1 (1) | 55 (55) | 0/1 | 0 type 1, 1 type 2, 0 variable | 0 yes, 1 no |
| Miscellaneous | 2 (2) | 22.5 ± 0.7 (22–23) | 1/1 | 2 type 1, 1 type 2, 1 variable | 1 yes, 1 no |
∗ Adapted from Baranchuk et al.
† Updated category of Brugada phenocopy on the basis of inappropriate ECG high-pass filtering.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
