Case Report

Brugada Syndrome Unmasked by Lithium

Authors: Preeti A. Chandra MD, Abhinav B. Chandra MD, MSc

Abstract

Abstract:A 38-year-old man was brought by emergency medical service after resuscitation following cardiac arrest. The patient was found pulseless with a wide complex tachycardia. The patient had bipolar disorder and was on lithium, lamotrigine, and ziprasidone. His electrolytes and lithium levels were normal. An electrocardiogram (EKG) was performed the next day and showed type 1 Brugada pattern. Lithium was held. Electrophysiologists made a diagnosis of drug-unmasked Brugada syndrome. Lithium can unmask Brugada syndrome through its ability to block sodium channels, even at subtherapeutic concentrations. Physicians need to be aware of this potentially fatal drug effect and should monitor EKGs of patients on lithium.

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References

References1. Wilde AA, Antzelevitch C, Borggrefe M, et al; Study Group on the Molecular Basis of Arrhythmias of the European Society of Cardiology. Proposed diagnostic criteria for the Brugada syndrome. Eur Heart J 2002;23:1648–1654.WildeAA]]AntzelevitchC]]BorggrefeM&etal;Study Group on the Molecular Basis of Arrhythmias of the European Society of CardiologyProposed diagnostic criteria for the Brugada syndrome.Eur Heart J2002231648-16542. Antzelevitch C, Brugada P, Borggrefe M, et al. Brugada syndrome: report of the second consensus conference: endorsed by the Heart Rhythm Society and the European Heart Rhythm Association. Circulation 2005;111:659–670.AntzelevitchC]]BrugadaP]]BorggrefeM&etal;Brugada syndrome: report of the second consensus conference: endorsed by the Heart Rhythm Society and the European Heart Rhythm Association.Circulation2005111659-6703. Antzelevitch C, Brugada P, Brugada J, et al. Brugada syndrome: 1992–2002: a historical perspective. J Am Coll Cardiol 2003;41:1665–1671.AntzelevitchC]]BrugadaP]]BrugadaJ&etal;Brugada syndrome: 1992–2002: a historical perspective.J Am Coll Cardiol2003411665-16714. Fish JM, Antzelevitch C. Role of sodium and calcium channel block in unmasking the Brugada syndrome. Heart Rhythm 2004;1:210–217.FishJM]]AntzelevitchCRole of sodium and calcium channel block in unmasking the Brugada syndrome.Heart Rhythm20041210-2175. Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome: a multicenter report. J Am Coll Cardiol 1992;20:1391–1396.BrugadaP]]BrugadaJRight bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome: a multicenter report.J Am Coll Cardiol1992201391-13966. Darbar D, Yang T, Churchwell K, et al. Unmasking of brugada syndrome by lithium. Circulation 2005;112:1527–1531.DarbarD]]YangT]]ChurchwellK&etal;Unmasking of brugada syndrome by lithium.Circulation20051121527-15317. Mitchell JE, Mackenzie TB. Cardiac effects of lithium therapy in man: a review. J Clin Psychiatry 1982;43:47–51.MitchellJE]]MackenzieTBCardiac effects of lithium therapy in man: a review.J Clin Psychiatry19824347-51