Brugada electrocardiographic pattern due to tricyclic antidepressant overdose.
The Brugada syndrome is an arrhythmogenic disease with characteristic coved ST-segment elevation 2 mm or greater in the right precordial leads (type 1 Brugada electrocardiogram [ECG] pattern or "Brugada sign"] and is estimated to be responsible for at least 20% of sudden deaths in patients with structurally normal hearts [Circulation 2005;111(5):659-70]. The Brugada sign has been described in asymptomatic patients after exposure to various drugs. As published reports of the drug-induced Brugada sign have become increasingly prevalent, there is growing interest in the mechanisms responsible for this acquired ECG pattern and its clinical significance. We report a case of a patient who developed the type 1 Brugada ECG pattern after intentional overdose of a tricyclic antidepressant agent, review the literature concerning tricyclic antidepressant agent-induced Brugada sign, discuss potential mechanisms, and evaluate the clinical significance of this ECG abnormality.
Akhtar
Mateen
M
Division of Cardiology, San Francisco General Hospital, University of California at San Francisco Medical Center, San Francisco, CA 94143-0119, USA. makhtar@itsa.ucsf.edu
Goldschlager
Nora F
NF
D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000506:poisoning; D002037:Bundle-Branch Block / Q000139:chemically induced* / Q000175:diagnosis*; D002998:Clonazepam / Q000506:poisoning*; D003891:Desipramine / Q000506:poisoning*; D004338:Drug Combinations; D062787:Drug Overdose / Q000150:complications; D004562:Electrocardiography / Q000187:drug effects*; D006801:Humans; D008297:Male; D014693:Ventricular Fibrillation / Q000139:chemically induced* / Q000175:diagnosis*
D000929:Antidepressive Agents, Tricyclic; D004338:Drug Combinations; D002998:Clonazepam; D003891:Desipramine