Understanding Brugada Pattern in Elderly Patients with COVID-19: A Case Study

BACKGROUND Brugada syndrome is a hereditary condition characterized by sudden cardiac death or electrocardiogram (EKG)-documented ventricular arrhythmias or arrhythmia-related symptoms in patients without structural cardiac pathology. Brugada phenocopy is a condition with EKG changes consistent with Brugada syndrome, without any hereditary cause. SARS-CoV-2 is a respiratory virus associated with many cardiovascular complications, one of which is new-onset arrhythmia, including Brugada phenocopy or the unmasking of the Brugada syndrome. PPublished cases have revealed the emergence of Brugada pattern among patients with afebrile SARS-CoV-2 infection, suggesting a link with the virus itself and not simply fever. Treatment for Brugada syndrome and Brugada phenocopy involves avoidance of modulating factors that can generate recurrent Brugada patterns. Additional therapy for Brugada syndrome may include implantable cardioverter-defibrillator (ICD) placement, but this treatment was considered unnecessary for a Brugada phenocopy and too risky for a nonagenarian man. Asymptomatic Brugada phenocopy in a COVID-19 patient requires close observation to manage. CASE REPORT A nonagenarian man with SARS-CoV-2 infection presented with chest pain, mild fever, and a Brugada pattern on EKG. He was treated with steroids, remdesivir, and antipyretics, before his Brugada phenocopy resolved. CONCLUSIONS Brugada phenocopy is characterized by fluctuating ST elevations triggered by modulating factors, including electrolyte derangements, fever, infection, and various medications or drugs. Prompt management of Brugada phenocopy is necessary to avoid the development of malignant arrhythmias or sudden cardiac death. Differentiation of Brugada phenocopy and Brugada syndrome is essential to avoid unnecessary ICD placement for Brugada phenocopy.