Brugada pattern in a patient medicated with lamotrigine.
The authors report the case of a 52-year-old woman with depressive syndrome, treated with lamotrigine for about five months, who went to the emergency department for atypical precordial pain. The electrocardiogram (ECG) revealed a 2-mm downsloping ST-segment elevation and negative T waves in V1 and V2. Due to suspicion of ST-elevation acute coronary syndrome, cardiac catheterization was performed, which revealed normal coronary arteries. The initial ECG was suggestive of type 1 Brugada pattern, but subsequent serial ECGs were less typical. A flecainide test showed the same pattern. After discontinuation of lamotrigine reversal of the typical Brugada ECG pattern was observed. Although not currently contraindicated in Brugada syndrome, the antidepressant lamotrigine blocks sodium channels, which are usually inactivated in heart cell membranes in Brugada syndrome, and may be responsible for the expression of type 1 Brugada pattern.
Serviço de Cardiologia, Centro Hospitalar de Setúbal, EPE - Hospital de São Bernardo, Setúbal, Portugal. Electronic address: argrar84@hotmail.com.
Rita
R
Rodrigues
Pedro
P
Amador
Leandro
L
Rassi
Filipe
F
Seixo
Leonor
L
Parreira
Nuno
N
Fonseca
Luís
L
Soares
D000928:Antidepressive Agents / Q000009:adverse effects*; D053840:Brugada Syndrome / Q000139:chemically induced*; D005260:Female; D006801:Humans; D000077213:Lamotrigine; D008875:Middle Aged; D014227:Triazines / Q000009:adverse effects*
D000928:Antidepressive Agents; D014227:Triazines; D000077213:Lamotrigine
Brugada pattern; Brugada syndrome; Electrocardiogram; Eletrocardiograma; Fenocópia; Flecainide test; Lamotrigina; Lamotrigine; Padrão de Brugada; Phenocopy; Síndrome de Brugada; Teste de flecainida