Brugada syndrome ECG provoked by the selective serotonin reuptake inhibitor fluvoxamine.
A patient with an SCN5A p.W822X nonsense mutation, localized in the transmembrane region DII-S4 of the Na(v)1.5 sodium channel and leading to a non-expression of the mutant allele, was prescribed the selective serotonin reuptake inhibitor (SSRI) fluvoxamine (Floxyfral), 100 mg per day. His normal baseline ECG changed to a characteristic Brugada-Type-1-ECG pattern. To investigate whether fluvoxamine may reduce the cardiac sodium current, the effect of this drug was studied on the wild-type voltage-gated cardiac sodium channel Na(v)1.5 stably expressed in HEK293 cells. Patch-clamp recording showed a 50% inhibition of the current at a concentration of 57.3 microM. In our patient, no arrhythmia occurred but the proarrhythmic potential of SSRI in patients with SCN5A mutations cannot be excluded. Therefore, we advise 12-lead ECG control after administering SSRI in these patients.
Stirnimann
Guido
G
Institute of Clinical Pharmacology and Visceral Research, University of Bern, Bern, Switzerland.
Petitprez
Séverine
S
Abriel
Hugues
H
Schwick
Nicola G
NG
D000293:Adolescent; D053840:Brugada Syndrome / Q000139:chemically induced* / Q000175:diagnosis; D003863:Depression / Q000188:drug therapy; D004562:Electrocardiography; D016666:Fluvoxamine / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009124:Muscle Proteins / Q000235:genetics; D009154:Mutation / Q000235:genetics; D062554:NAV1.5 Voltage-Gated Sodium Channel; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D015222:Sodium Channels / Q000235:genetics
D016666:Fluvoxamine; D009124:Muscle Proteins; D062554:NAV1.5 Voltage-Gated Sodium Channel; D017367:Selective Serotonin Reuptake Inhibitors; D015222:Sodium Channels; C568320:SCN5A protein, human