Brugada electrocardiographic pattern elicited by cyclic antidepressants overdose.
OBJECTIVE
The Brugada syndrome is a clinical and electrocardiographic familial entity, which may lead to sudden cardiac death. A Brugada pattern ECG may occasionally be caused by conditions such as an overdose of tricyclic antidepressants (TCA). Toxicity of TCA frequently results in the need for critical care support. We retrospectively studied characteristics and electrocardiographic indicators of toxicity of all TCA poisoned patients.


METHODS
All patients admitted from 1/1/2000 to 1/11/2004 to our ICU after an act of deliberate self-poisoning were included. The ECG's were analysed retrospectively by a cardiologist. Patients with an overdose of TCA were divided in three groups; I. without ECG abnormalities, II. Presence of ECG abnormalities but without Brugada signs, III patients with a Brugada pattern ECG.


RESULTS
134 patients were admitted. In 35 patients a TCA was the main toxic substance. In 12 (34%) TCA patients no ECG abnormalities were found. An increase in QRS duration (>100 ms) was seen in 13 (37%) cases. Six (17%) of them demonstrated a Brugada like pattern. The ECG abnormalities resolved quickly after administration of sodium bicarbonate. Length of stay did not differ between groups. APACHE II and the amount of sodium bicarbonate administered were the highest in the Brugada pattern group. Two patients died.


CONCLUSIONS
in TCA poisoning the Brugada pattern ECG is a particular manifestation of the frequently occurring intraventricular conduction disturbances. In intoxicated patients in whom the substance is unknown early recognition of the conduction disturbances is important for suspecting a poisoning with TCA.
Monteban-Kooistra
Wilma E
WE
Intensive & Respiratory Care Unit (ICB), Dept. Cardiology, University Medical Center Groningen, 30.001, 9700 RB, Groningen, Netherlands.
van den Berg
Maarten P
MP
Intensive & Respiratory Care Unit (ICB), Dept. Cardiology, University Medical Center Groningen, 30.001, 9700 RB, Groningen, Netherlands.
Tulleken
Jaap E
JE
Intensive & Respiratory Care Unit (ICB), Dept. Cardiology, University Medical Center Groningen, 30.001, 9700 RB, Groningen, Netherlands. j.e.tulleken@int.umcg.nl.
Ligtenberg
Jack J M
JJM
Intensive & Respiratory Care Unit (ICB), Dept. Cardiology, University Medical Center Groningen, 30.001, 9700 RB, Groningen, Netherlands.
Meertens
John H J M
JHJM
Intensive & Respiratory Care Unit (ICB), Dept. Cardiology, University Medical Center Groningen, 30.001, 9700 RB, Groningen, Netherlands.
Zijlstra
Jan G
JG
Intensive & Respiratory Care Unit (ICB), Dept. Cardiology, University Medical Center Groningen, 30.001, 9700 RB, Groningen, Netherlands.
D000328:Adult; D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000506:poisoning*; D053840:Brugada Syndrome / Q000139:chemically induced* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013406:Suicide, Attempted
D000929:Antidepressive Agents, Tricyclic