{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T15:57:33Z","timestamp":1792598253591,"version":"4.5.0"},"reference-count":7,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:00:00Z","timestamp":1790380800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Brugada syndrome is an inherited arrhythmogenic channelopathy associated with an increased risk of sudden cardiac death. Diagnosis relies on the presence of a spontaneous type 1 Brugada pattern on electrocardiogram (ECG). While multiple hypotheses have been proposed to explain its underlying mechanism, it is generally thought to be secondary to defective myocardial sodium channels. For this reason, sodium channel-blocking medications can induce a type 1 Brugada pattern, which may complicate risk stratification and raise the possibility of Brugada phenocopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 44-year-old man on regular amitriptyline 75\u2005mg for anxiety and panic disorder presented with two episodes of syncope. ECG showed classical features of a type 1 Brugada pattern. Routine blood investigations, including full blood count, renal function tests, a comprehensive electrolyte panel, and high-sensitivity troponin, were normal. Transthoracic echocardiography revealed normal cardiac structure and function. Following multidisciplinary team (MDT) discussion, and guided by the 2022 European Society of Cardiology (ESC) guidelines, a shared decision was made to proceed with implantable cardioverter-defibrillator (ICD) implantation. The patient was discharged with follow-up in the arrhythmia clinic and referred for genetic testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case highlighted the diagnostic and management challenges of differentiating true Brugada syndrome from drug-induced Brugada phenocopy. Although our patient had type 1 Brugada ECG pattern in the context of amitriptyline use, his presentation with syncope complicates risk stratification. MDT discussion and reference to ESC guidelines played a key role in determining further management, which in this case was ICD implantation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag710","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T11:24:37Z","timestamp":1790335477000},"source":"Crossref","is-referenced-by-count":0,"title":["Recurrent syncope with a type 1 Brugada electrocardiogram pattern in a patient on amitriptyline: Brugada syndrome vs. phenocopy\u2014a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7750-8860","authenticated-orcid":false,"given":"Muhammad K","family":"Asyraf","sequence":"first","affiliation":[{"name":"Department of Cardiology, University Hospital Waterford , Dunmore Road, Waterford, X91 ER8E ,","place":["Ireland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Smyth","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Waterford , Dunmore Road, Waterford, X91 ER8E ,","place":["Ireland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5590-5665","authenticated-orcid":false,"given":"Sajjad","family":"Matiullah","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Waterford , Dunmore Road, Waterford, X91 ER8E ,","place":["Ireland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,26]]},"reference":[{"key":"2026102111365549300_ytag710-B1","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/j.jacc.2018.06.037","article-title":"Present Status of Brugada syndrome","volume":"72","author":"Brugada","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2026102111365549300_ytag710-B2","doi-asserted-by":"crossref","first-page":"3997","DOI":"10.1093\/eurheartj\/ehac262","article-title":"2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death","volume":"43","author":"Zeppenfeld","year":"2022","journal-title":"Eur Heart J"},{"key":"2026102111365549300_ytag710-B3","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9781615371624","volume-title":"The American Psychiatric Association Publishing Textbook of Psychopharmacology","author":"Schatzberg","year":"2017"},{"key":"2026102111365549300_ytag710-B4","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1056\/NEJM200205163462020","article-title":"Overdose of cyclic antidepressants and the Brugada syndrome","volume":"346","author":"Goldgran-Toledano","year":"2002","journal-title":"N Engl J Med"},{"key":"2026102111365549300_ytag710-B5","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1046\/j.1540-8167.2001.00275.x","article-title":"Brugada syndrome mimicked by tricyclic antidepressant overdose","volume":"12","author":"Tada","year":"2001","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2026102111365549300_ytag710-B6","first-page":"358","article-title":"Brugada syndrome induced by amitriptyline toxicity","volume":"66","author":"Mooren","year":"2008","journal-title":"Neth J Med"},{"key":"2026102111365549300_ytag710-B7","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.jaccas.2020.11.016","article-title":"The Brugada type 1 electrocardiogram and ventricular tachycardia with high-dose amitriptyline","volume":"3","author":"Chow","year":"2021","journal-title":"JACC Case Rep"}],"container-title":["European Heart Journal - 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