Among patients with severe hyperkalemia resulting from a critical medical condition, the Brugada electrocardiogram (ECG) pattern, also known as the Brugada phenotype (BrPh), is associated with a high prevalence of malignant arrhythmias and all-cause mortality, according to a new study.

“Prompt recognition of this clinical-morphological entity and immediate treatment of hyperkalemia and surveillance of potential life-threatening arrhythmias is strong recommended,” first author Allan Rivera-Juárez , MD, PhD, of Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón Facultad de Medicina Universidad Complutense Madrid Spain, and colleagues reported in the Journal of the American Heart Association. “Drug-provocation testing following normalization of serum potassium levels may be considered to uncover underlying Brugada syndrome.”

Brugada syndrome is characterized by distinctive ST-segment elevation in the right precordial leads of an ECG, according to the investigators. The syndrome has been considered a primary electric cardiac disease caused by mutations in genes coding potassium, sodium, and calcium channels in approximately 30% of patients, they noted.

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Dr Rivera-Juárez  and his collaborators studied 15 patients who presented with severe hyperkalemia with a BrPh ECG that was transient and resolved following normalization of serum potassium. Most patients were admitted because of various severe medical conditions causing hyperkalemia. Six (40%) presented with malignant arrhythmias and 6 died during admission. Higher serum potassium levels and male sex were associated with significant 16-fold and 17-fold increased odds of BrPh ECG among patients with severe hyperkalemia, respectively.


Rivera-Juárez A, Hernández-Romero I, Puertas C, et al. Clinical characteristics and electrophysiological mechanisms underlying Brugada ECG in patients with severe hyperkalemiaJ Am Heart Assoc. 2019;8:e010115.