Mechanism behind hyperkalemic brugada phenocopy: A computational study

Brugada Phenocopy (BrP) describes an ECG pattern that imitates the morphology of a congenital Brugada Syndrome, but is caused by various other factors, such as metabolic abnormalities, ischemia or others. Understanding the underlying mechanisms of BrP can improve the outcome of these patients. This study proposes an explanation to BrP cases elicited by hyperkalemia. A 3D wedge model of right ventricle was implemented, along with a transmural cell gradient of endocardial, mid-myocardial and epicardial cell. Two protocols of stimulation were designed to introduce a delay of activation in the model. Computer simulations were performed increasing the amount of extracellular potassium from healthy stage to hyperkalemic condition and pseudoECGs were calculated. Delay of activation and heterogeneity of conduction velocity are linked of Brugada Phenocopy in a hyperkalemic stage. Increasing extracellular potassium promotes these differences, due to elevation of resting potential and lower availability of sodium channels.