AbstractIntroductionDynamic ECG changes in Brugada syndrome (BrS) are influenced by several factors, may not be apparent, and can be unmasked by a drug test.Methods and ResultsFour of six patients with nondiagnostic Brugada ECG index patterns underwent a dextrose‐insulin challenge test that resulted in J‐ST segment elevation and triggered arrhythmias.ConclusionInsulin action may be due in part to an outward shift in the K+ current at the end of action potential phase 1 and the dispersion of repolarization, leading to local re‐entry with arrhythmogenicity. This effect is likely a phenomenon‐specific to BrS.

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