rforming a challenge test with flecainide to rule out Brugada ndrome. Until the prognosis of patients presenting with Sopathies: From Noonan to LEOPARD Syndrome Sopatı́as: del sı́ndrome de Noonan al sı́ndrome LEOPARD

The authors appreciate the interest in the case report we blished in Revista Española de Cardiologı́a concerning the servation of the Brugada electrocardiographic (ECG) pattern in patient with hyperkalemia. We likewise welcome the introducn of the concept of phenocopy, an expression with which our ding is compatible.We also consider it opportune to stress that th the latest consensus on ECG diagnosis of Brugada syndrome d the introduction of the term phenocopy are more recent than the line publication of our case report in 2011. The definitions of e ECG patterns that are typical of Brugada syndrome and those that imic this syndrome in the presence of serum electrolyte sturbances were introduced subsequent to our publication. It is important to highlight reasons for attributing the changes served in the ECG to hyperkalemia rather than to the acidosis d hyponatremia also observed in our patient. Reports of Brugada enocopy associated with hyponatremia and acidosis have scribed the development of pseudo J waves in the QRS complex d ST segment depression in leads other than right precordial ads. These are precisely the features that differentiate this ECG ttern from type 1 Brugada pattern. Other possible causes yperglycemia, drugs, fever, and myocardial ischemia) were ruled t in the case discussed in our report. We appreciate any contribution that aids in the understanding the mechanisms involved in the induction of ECG patterns imicking Brugada syndrome (phenocopies) and other patterns, ch as early repolarization, which can also be associated with the k of sudden cardiac death. Finally, we agree with Dr. Anselm on the importance of rforming a challenge test with flecainide to rule out Brugada ndrome. Until the prognosis of patients presenting with