Propafenone Overdose Presenting With Brugada Phenocopy, QRS Widening, and Ventricular Fibrillation

BACKGROUND: Brugada phenocopy (BrP) denotes reversible Brugada-type electrocardiogram changes from transient triggers, requiring management distinct from congenital Brugada syndrome. CASE SUMMARY: . A review of his phone confirmed propafenone ingestion (approximately 2.5 g over 3 days). Intravenous sodium bicarbonate led to rapid QRS interval narrowing and clinical stabilization. DISCUSSION: coved morphology, and J-waves in acidemia with dose-verified exposure supports drug-induced BrP. Early bicarbonate reverses sodium-channel blockade; normalization and normal cardiac magnetic resonance argue against a fixed substrate, so implantable cardioverter-defibrillator is unnecessary. TAKE-HOME MESSAGES: BrP resolves after correcting reversible triggers. In sodium-channel blocker toxicity with QRS interval widening, early sodium bicarbonate is first-line therapy.