What is the clinical evidence from this study?

Study design: Case Report. Population: Brugada syndrome versus phenocopy (n=1). Intervention: Amitriptyline.

What does this research mean for the field?

Sodium channel-blocking drugs such as amitriptyline can induce a type 1 Brugada ECG pattern, presenting diagnostic challenges in differentiating true Brugada syndrome from Brugada phenocopy in patients with syncope. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

To evaluate the diagnostic dilemma between true inherited Brugada syndrome and drug-induced Brugada phenocopy in a symptomatic patient receiving amitriptyline therapy.

September 28, 2026European Heart Journal - Case ReportsOpen Access

Recurrent syncope with a type 1 Brugada ECG pattern in a patient on amitriptyline: Brugada syndrome versus phenocopy − a case report

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Key result

Amitriptyline use is linked to a type 1 Brugada pattern and syncope requiring an ICD.

Population

44-year-old man on regular amitriptyline 75 mg for anxiety and panic disorder, presenting with two episodes…

Design

Case_report

Authors

MAMuhammad Khairul Asyraf PSPhilip Smyth SMSajjad MatiullahUniversity Hospital Waterford

Discussion

Member takes

Implication

Amitriptyline may induce Brugada pattern with syncope; supports ESC guidance but leaves open genetic testing role in phenocopies.

Key Points

To evaluate the diagnostic dilemma between true inherited Brugada syndrome and drug-induced Brugada phenocopy in a symptomatic patient receiving amitriptyline therapy.
Evaluated a 44-year-old male on maintenance amitriptyline (75 mg daily) presenting with recurrent syncope using electrocardiography, echocardiography, and laboratory panels.
Applied 2022 European Society of Cardiology guidelines within a multidisciplinary team framework to determine optimal risk stratification and management.
Electrocardiography demonstrated a classical type 1 Brugada pattern despite structurally normal cardiac imaging on echocardiogram and normal electrolyte levels.
Given the presence of recurrent syncope and high sudden cardiac death risk, the multidisciplinary team recommended implantable cardioverter-defibrillator placement and outpatient genetic testing.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

A 44-year-old man on regular amitriptyline 75 mg for anxiety and panic disorder who presented with two episodes of syncope and a type 1 Brugada ECG pattern.

Exposure

Implantable cardioverter-defibrillator (ICD) implantation

Outcome

Management of syncope with type 1 Brugada pattern in the context of amitriptyline use

This case highlights the diagnostic and management challenges of differentiating true Brugada syndrome from drug-induced Brugada phenocopy in a patient on amitriptyline presenting with syncope.

Cite This Study

Asyraf et al. (2026) conducted a case report in Brugada syndrome versus phenocopy (n=1). Amitriptyline was evaluated. Amitriptyline use in a 44-year-old man was associated with 2 episodes of syncope and a type 1 Brugada ECG pattern, necessitating ICD implantation.

synapsesocial.com/papers/6ab9b61e7822ec8fc3d91a6c https://doi.org/10.1093/ehjcr/ytag710

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