Europace Advance Access published online on October 29, 2009
Europace, doi:10.1093/europace/eup332
SHORT COMMUNICATION
Brugada syndrome ECG provoked by the selective serotonin reuptake inhibitor fluvoxamine
1 Institute of Clinical Pharmacology and Visceral Research, University of Bern, Bern, Switzerland; 2 Department of Clinical Research, University of Bern, Bern, Switzerland; 3 Swiss Cardiovascular Center Bern, Inselspital, University Hospital and University of Bern, CH-3010 Bern, Switzerland
A patient with an SCN5A p.W822X nonsense mutation, localized in the transmembrane region DII-S4 of the Nav1.5 sodium channel and leading to a non-expression of the mutant allele, was prescribed the selective serotonin reuptake inhibitor (SSRI) fluvoxamine (Floxyfral®), 100 mg per day. His normal baseline ECG changed to a characteristic Brugada-Type-1-ECG pattern. To investigate whether fluvoxamine may reduce the cardiac sodium current, the effect of this drug was studied on the wild-type voltage-gated cardiac sodium channel Nav1.5 stably expressed in HEK293 cells. Patch-clamp recording showed a 50% inhibition of the current at a concentration of 57.3 µM. In our patient, no arrhythmia occurred but the proarrhythmic potential of SSRI in patients with SCN5A mutations cannot be excluded. Therefore, we advise 12-lead ECG control after administering SSRI in these patients.
* Corresponding author. Tel: +41 31 632 0337, Fax: +41 31 632 1414, Email: nicola.schwick{at}insel.ch
Manuscript submitted 17 August 2009. Accepted after revision 28 September 2009.