title: Class I antiarrhythmic drug and coronary vasospasm-induced T wave alternans and ventricular tachyarrhythmia in a patient with Brugada syndrome and vasospastic angina.
abstract: A 50-year-old man presented with a history of transient chest pain and palpitations. The 12-lead ECG at rest showed normal sinus rhythm. A slight ST segment elevation was observed in leads V1 to V3. During hospitalization, atrial fibrillation developed, and oral pilsicainide was administered. Thirty minutes after the drug was given, the ECG showed marked ST segment elevation in leads V1 to V3, and T wave alternans became visible in leads V2 and V3. Self-terminating ventricular tachycardia was initiated following frequent ventricular premature complexes, which showed a left bundle branch block pattern. The coronary angiogram was normal, but in the provocation test of vasospastic angina, acetylcholine administration into the left coronary artery resulted in complete occlusion of the left anterior descending and circumflex arteries. Marked ST segment elevation developed in leads I, aVL, and V3 to V6 concomitant with visible QT/T alternans in leads V4 and V5, and ventricular tachyarrhythmia was initiated. Brugada syndrome and vasospastic angina coexisted in this patient, and T wave alternans can be used as a predictor of ventricular tachyarrhythmias in such patients.
authors.affiliation: First Department of Internal Medicine, Niigata University School of Medicine, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Chinushi
authors.forename: Masaomi
authors.initials: M
authors.lastname: Chinushi
authors.forename: Tatunari
authors.initials: T
authors.lastname: Toida
authors.forename: Yoshifusa
authors.initials: Y
authors.lastname: Aizawa
mesh_terms: D000109:Acetylcholine / Q000009:adverse effects*; D000788:Angina Pectoris, Variant / Q000139:chemically induced* / Q000175:diagnosis; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced*; D001281:Atrial Fibrillation / Q000188:drug therapy; D002037:Bundle-Branch Block / Q000139:chemically induced; D006801:Humans; D008012:Lidocaine / Q000009:adverse effects* / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000139:chemically induced; D014665:Vasodilator Agents / Q000009:adverse effects*; D018879:Ventricular Premature Complexes / Q000139:chemically induced
chemical_list: D000889:Anti-Arrhythmia Agents; D014665:Vasodilator Agents; D008012:Lidocaine; C042288:pilsicainide; D000109:Acetylcholine