Type 1 Brugada pattern ECG due to supra-therapeutic phenytoin level

Brugada syndrome is an inherited arrhythmogenic disease, characterised by a coved-type ST segment elevation in right precordial leads and an increased risk of sudden cardiac death due to ventricular arrhythmia. To unmask or exacerbate a Brugada ECG pattern, class IA or IC antiarrhythmic agents are u...

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Bibliographic Details
Published in:BMJ case reports 2016-06, Vol.2016, p.bcr2016214899
Main Authors: Swe, Thein, Bhattarai, Bikash, Dufresne, Alix
Format: Article
Language:English
Subjects:
Aftercare
Anticonvulsants - administration & dosage
Anticonvulsants - poisoning
Black
Brugada Syndrome - chemically induced
Cardiac arrhythmia
Convulsions & seizures
Drug dosages
Drug Overdose - psychology
Dyspnea
Electrocardiography
Fainting
Fractures
Heart attacks
Hospitals
Humans
Male
Memory Disorders - complications
Middle Aged
Patients
Phenytoin - administration & dosage
Phenytoin - poisoning
Seizures - drug therapy
Unusual Association of Diseases/Symptoms
USA/Canada
X-rays
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Summary:Brugada syndrome is an inherited arrhythmogenic disease, characterised by a coved-type ST segment elevation in right precordial leads and an increased risk of sudden cardiac death due to ventricular arrhythmia. To unmask or exacerbate a Brugada ECG pattern, class IA or IC antiarrhythmic agents are used, and clinicians can predict sudden cardiac death in a high-risk patient. However, phenytoin, one of the class IB agents, may induce a Brugada pattern ECG at a supra-therapeutic level and this association has rarely been reported. We describe a case of a patient with a phenytoin level about twice as high as the therapeutic level, which led to the emergence of a type 1 Brugada pattern ECG. Awareness should be made between this important association of supra-therapeutic phenytoin level and type 1 Brugada pattern ECG because symptomatic Brugada syndrome can lead to sudden cardiac death.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2016-214899