title: Brugada Pattern Caused by a Flecainide Overdose.
abstract: BACKGROUND
  Brugada pattern can be found on the electrocardiogram (ECG) of patients with altered mental status, usually with fever or drug intoxication. Diagnosis remains challenging, because the ECG changes are dynamic and variable. In addition, triggers are not always clearly identified. In patients with atrial fibrillation (AF), the use of class IC antidysrhythmic drugs can unmask a Brugada pattern on the ECG, especially if combined with other medications acting on sodium channels.
  
  
  METHODS
  A 62-year-old man with a medical history of AF was admitted to our emergency department for altered mental status. The ECG at the time of admission showed a Brugada pattern, triggered by a flecainide overdose (about 1 g), in association with an unknown dose of lamotrigine and quetiapine. After discontinuation of all medications, the Brugada pattern disappeared and his ECG showed no abnormalities. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In patients with AF, the use of class IC antidysrhythmic drugs, if overdosed, can trigger a Brugada ECG pattern, and therefore it can increase the risk for malignant dysrhythmias. It is important to provide, to all patients with a Brugada ECG pattern, a list of drugs to avoid, and to underline the synergistic interplay between drugs, taking into consideration all patients' comorbidities.
authors.affiliation: Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Elena
authors.initials: E
authors.lastname: Tessitore
authors.affiliation: Department of Emergency Medicine, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Majd
authors.initials: M
authors.lastname: Ramlawi
authors.affiliation: Department of Emergency Medicine, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Tobler
authors.affiliation: Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Henri
authors.initials: H
authors.lastname: Sunthorn
mesh_terms: D001281:Atrial Fibrillation / Q000188:drug therapy; D001714:Bipolar Disorder / Q000150:complications / Q000523:psychology; D053840:Brugada Syndrome / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology*; D003244:Consciousness Disorders / Q000209:etiology; D062787:Drug Overdose / Q000628:therapy; D004562:Electrocardiography / Q000379:methods; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005424:Flecainide / Q000506:poisoning*; D006801:Humans; D000077213:Lamotrigine; D008297:Male; D008875:Middle Aged; D000069348:Quetiapine Fumarate / Q000506:poisoning / Q000627:therapeutic use; D026941:Sodium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use; D020521:Stroke; D013406:Suicide, Attempted / Q000523:psychology; D014227:Triazines / Q000506:poisoning / Q000627:therapeutic use
chemical_list: D026941:Sodium Channel Blockers; D014227:Triazines; D000069348:Quetiapine Fumarate; D005424:Flecainide; D000077213:Lamotrigine
keywords: Brugada pattern; ECG changes; flecainide intoxication