title: Type 1 Brugada pattern ECG due to supra-therapeutic phenytoin level.
abstract: Brugada syndrome is an inherited arrhythmogenic disease, characterised by a coved-type ST segment elevation in right precordial leads and an increased risk of sudden cardiac death due to ventricular arrhythmia. To unmask or exacerbate a Brugada ECG pattern, class IA or IC antiarrhythmic agents are used, and clinicians can predict sudden cardiac death in a high-risk patient. However, phenytoin, one of the class IB agents, may induce a Brugada pattern ECG at a supra-therapeutic level and this association has rarely been reported. We describe a case of a patient with a phenytoin level about twice as high as the therapeutic level, which led to the emergence of a type 1 Brugada pattern ECG. Awareness should be made between this important association of supra-therapeutic phenytoin level and type 1 Brugada pattern ECG because symptomatic Brugada syndrome can lead to sudden cardiac death.
authors.affiliation: Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York, USA.
authors.forename: Thein
authors.initials: T
authors.lastname: Swe
authors.affiliation: Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York, USA.
authors.forename: Bikash
authors.initials: B
authors.lastname: Bhattarai
authors.affiliation: Head of Cardiology Department, Interfaith Medical Center, Brooklyn, New York, USA.
authors.forename: Alix
authors.initials: A
authors.lastname: Dufresne
mesh_terms: D000359:Aftercare; D000927:Anticonvulsants / Q000008:administration & dosage / Q000506:poisoning*; D053840:Brugada Syndrome / Q000139:chemically induced*; D062787:Drug Overdose / Q000523:psychology; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000150:complications; D008875:Middle Aged; D010672:Phenytoin / Q000008:administration & dosage / Q000506:poisoning*; D012640:Seizures / Q000188:drug therapy
chemical_list: D000927:Anticonvulsants; D010672:Phenytoin