Intravenous administration of class I antiarrhythmic drugs induced T wave alternans in a patient with Brugada syndrome.
A 71-year-old man who experienced aborted sudden death was referred to our hospital. Coronary artery disease and cerebral accident were ruled out by conventional tests. The 12-lead ECG obtained at rest showed a right bundle branch block pattern and ST segment elevation in leads V1 to V3. Double ventricular extrastimuli at coupling intervals >180 msec induced ventricular fibrillation (VF) twice during electrophysiologic study. Intravenous administration of procainamide accentuated ST segment elevation in leads V1 to V3, and visible T wave alternans was induced in leads V2 and V3 at a dose of 450 mg. Initiation of T wave alternans was not associated with changes of the cardiac cycle or development of premature beats. When procainamide infusion was discontinued, T wave alternans disappeared before the elevated ST segment returned to the control level. Pilsicainide also accentuated ST segment elevation and induced similar T wave alternans in leads V2 and V3. Class I antiarrhythmic drug-related T wave alternans has been reported rarely in Brugada syndrome, but it may represent enhanced arrhythmogenicity of VF. We need to monitor closely and study the clinical implications of T wave alternans in Brugada syndrome.
Chinushi
M
M
First Department of Internal Medicine, Niigata University School of Medicine, Japan. chinushi@med.niigata-u.ac.jp
Washizuka
T
T
Okumura
H
H
Aizawa
Y
Y
D000368:Aged; D000889:Anti-Arrhythmia Agents; D002037:Bundle-Branch Block / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology* / Q000601:surgery; D002304:Cardiac Pacing, Artificial; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D004594:Electrophysiology; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D011342:Procainamide; D013577:Syndrome; D014693:Ventricular Fibrillation / Q000209:etiology
D000889:Anti-Arrhythmia Agents; D011342:Procainamide