Response to Letter Regarding Article, “Induced Brugada-Type Electrocardiogram, a Sign for Imminent Malignant Arrhythmias”
We* thank Drs Behr and Camm for their comments on our study.1 We could not agree more. Referral centers have a bias in their population because they will receive the most severe forms of a disease. Likewise, all disease registries, especially those dedicated to diseases with a low prevalence, have an intrinsic bias. It is highly likely that a patient who has had an adverse reaction will be more easily noticed and incorporated into a registry and that without the adverse reaction, the physician will miss the uncommon phenotype. Likewise, it is likely that those cases in which the physician feels he or she could have done better will not be sent to a registry. This is just human nature.
Nevertheless, in medicine, we often use case reports as the proof of concept for the adoption of medical preventive guidelines, be it stopping exercise in some diseases or avoiding medications in individuals with certain genotypes. On the basis of minimal data, we discontinue first, and then we hope that time and further recruitment will prove or refute whether the association was correct.
The present work was not meant to be a systematic or longitudinal study of medications that induce a Brugada ECG pattern. This is a collection of case reports of induced Brugada ECG pattern that we have received and evaluated and in which we show that half of the population presented with malignant arrhythmias. Considering that these are young individuals, most of whom were previously healthy, we think that this is of tremendous importance. We provide clear evidence, despite the bias, that the induction of the ECG pattern under an acute process or medication may be followed by the triggering of malignant arrhythmias. How common is this presentation? We do not know; monitoring is not always performed for the right precordial leads, and few noncardiac physicians are aware of what ST elevation in V1-V2 means during anesthesia.
In any case, we believe that this is not an ECG pattern that can be disregarded in an individual who presents with an acute process, because it can give you a big scare. That was the main message of our report.
↵*Maday Gonzalez and Eric Lizotte were not available at the time of this response.