Multifactorial Brugada Phenocopy

To the Editor We read with interest the article by Heckle et al¹ recently published in the Challenges in Clinical Electrocardiography section of JAMA Internal Medicine. The authors addressed the case of a woman in her 50s who presented with altered mental status and respiratory distress requiring intubation in the field. An electrocardiogram (ECG) was recorded on presentation, which was interpreted by the authors as a normal sinus rhythm with a right bundle branch pattern and loss of P-wave amplitude in the precordial leads. It was pointed out that the most profound ECG abnormality was the greater than 5-mm coved-type ST-segment elevation in leads V₁ to V₂ with the presence of Q waves. After decreasing the potassium level, the ECG no longer presented segment elevation in leads V₁ to V₂.