title: Drug-induced Brugada syndrome: Clinical characteristics and risk factors.
abstract: Cardiac arrest may result from seemingly innocuous medications that do not necessarily have cardiac indications. The best-known example is the drug-induced long QT syndrome. A less known but not necessarily less important form of drug-induced proarrhythmia is the drug-induced Brugada syndrome.
  
  
  
  The purpose of this study was to identify clinical and ECG risk markers for drug-induced Brugada syndrome.
  
  
  
  Reports of drug-induced Brugada syndrome recounted by an international database (http://www.brugadadrugs.org) were reviewed to define characteristics that identify patients prone to developing this complication. For each patient with drug-induced Brugada syndrome who had an ECG recorded in the absence of drugs, we included 5 healthy controls matched by gender and age. All ECGs were evaluated for Brugada-like abnormalities.
  
  
  
  Seventy-four cases of drug-induced Brugada syndrome from noncardiac medications were identified: 77% were male, and drug toxicity was involved in 46%. Drug-induced Brugada syndrome from oral medications generally occurred weeks after the initiation of therapy. Mortality was 13%. By definition, all cases had a type I Brugada pattern during drug therapy. Nevertheless, their ECG in the absence of drugs was more frequently abnormal than the ECG of controls (56% vs 33%, P = .04).
  
  
  
  Drug-induced Brugada syndrome from noncardiac drugs occurs predominantly in adult males, is frequently due to drug toxicity, and occurs late after the onset of therapy. Minor changes are frequently noticeable on baseline ECG, but screening is impractical because of a prohibitive false-positive rate.
authors.affiliation: Tel-Aviv Sourasky Medical Center, Sackler-School of Medicine, Tel-Aviv University, Israel.
authors.forename: Maayan
authors.initials: M
authors.lastname: Konigstein
authors.affiliation: Tel-Aviv Sourasky Medical Center, Sackler-School of Medicine, Tel-Aviv University, Israel.
authors.forename: Raphael
authors.initials: R
authors.lastname: Rosso
authors.affiliation: Tel-Aviv Sourasky Medical Center, Sackler-School of Medicine, Tel-Aviv University, Israel.
authors.forename: Guy
authors.initials: G
authors.lastname: Topaz
authors.affiliation: Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Pieter G
authors.initials: PG
authors.lastname: Postema
authors.affiliation: Tel-Aviv Sourasky Medical Center, Sackler-School of Medicine, Tel-Aviv University, Israel.
authors.forename: Limor
authors.initials: L
authors.lastname: Friedensohn
authors.affiliation: Tel-Aviv Sourasky Medical Center, Sackler-School of Medicine, Tel-Aviv University, Israel.
authors.forename: Karin
authors.initials: K
authors.lastname: Heller
authors.affiliation: Tel-Aviv Sourasky Medical Center, Sackler-School of Medicine, Tel-Aviv University, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Zeltser
authors.affiliation: Tel-Aviv Sourasky Medical Center, Sackler-School of Medicine, Tel-Aviv University, Israel.
authors.forename: Bernard
authors.initials: B
authors.lastname: Belhassen
authors.affiliation: Tel-Aviv Sourasky Medical Center, Sackler-School of Medicine, Tel-Aviv University, Israel.
authors.forename: Arnon
authors.initials: A
authors.lastname: Adler
authors.affiliation: Tel-Aviv Sourasky Medical Center, Sackler-School of Medicine, Tel-Aviv University, Israel. Electronic address: samiviskin@gmail.com.
authors.forename: Sami
authors.initials: S
authors.lastname: Viskin
mesh_terms: D000328:Adult; D000367:Age Factors; D053840:Brugada Syndrome / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D004333:Drug Administration Routes; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000453:epidemiology; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006329:Heart Conduction System / Q000187:drug effects; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors
keywords: Brugada syndrome; Drugs; Electrocardiography; Heart arrest