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Europace Advance Access originally published online on May 29, 2009
Europace 2009 11(8):989-994; doi:10.1093/europace/eup114
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

REVIEWS

Drug-induced Brugada syndrome

Yee Guan Yap1,*, Elijah R. Behr2 and A. John Camm2

1 Department of Cardiology, Heart and Lung Centre, Prince Court Medical Centre, 39, Jalan Kia Peng, Kuala Lumpur 50450, Malaysia; 2 Division of Cardiac and Vascular Sciences, St George's University of London, London, UK

Brugada syndrome is an inherited cardiac arrhythmia condition characterized by (i) coved ST-elevation and J point elevation of at least 2 mm in at least two of the right precordial ECG leads (V1–V3) and (ii) ventricular arrhythmias, syncope, and sudden death. Patients with Brugada syndrome or suspected mutation carriers can have normal ECG recordings at other times. In these cases, a diagnostic challenge with a sodium channel blocker such as ajmaline, flecainide, or pilsicainide may induce the full-blown type 1 ECG pattern and support the diagnosis. However, recently, many other pharmacological agents not related to class I anti-arrhythmic agents have been reported to induce Brugada ECG patterns including tricyclic antidepressants, fluoxetine, lithium, trifluoperazine, antihistamines, and cocaine. As published reports of the drug-induced Brugada sign have become increasingly prevalent, there is growing interest in the mechanisms responsible for this acquired ECG pattern and its clinical significance. It is possible that drug-induced Brugada syndrome may be due to an individual susceptibility that favours drug-induced ECG abnormalities, possibly as a result of an increase in a latent ion channel dysfunction similar to that in drug-induced long QT syndrome. However, further evidence is needed to confirm this postulation. In this paper, we will review the cases and evidence of drug-induced Brugada syndrome reported in the literature.

Key Words: Drug-induced Brugada syndrome, Sudden cardiac death

* Corresponding author. Tel: +603 21600000, Fax: +603 21600680, Email: ygyap{at}aol.com

Manuscript submitted 4 January 2009. Accepted after revision 15 April 2009.


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