ST segment elevation in the right precordial leads following administration of class Ic antiarrhythmic drugs

Yasuda, Masayuki; Nakazato, Yuji; Yamashita, Haruyo; Sekita, Gaku; Kawano, Yasunobu; Mineda, Yoriaki; Nakazato, Kaoru; Tokano, Takashi; Sumiyoshi, Masataka; Nakata, Yasuro

doi:10.1136/heart.85.1.e3

Cited by 11 publications

(11 citation statements)

References 13 publications

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“…Class IA or IC drugs reportedly are useful for risk stratification of Brugada syndrome by manifesting precordial ST elevation 6 . However, some patients have not experienced episodes of syncope or ventricular fibrillation even though these drugs induced abnormal ST elevation in the patients 7,8 . Thus, the diagnosis of Brugada syndrome may be difficult, particularly in patients in whom ST elevation is not initially apparent.…”

Section: Discussionmentioning

confidence: 99%

Manifestation of Brugada Syndrome After Pacemaker Implantation in a Patient with Sick Sinus Syndrome

Nakazato

Suzuki

Yasuda

et al. 2004

Cardiovasc electrophysiol

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A 49-year-old woman experienced syncope 10 months after DDD pacemaker implantation for sick sinus syndrome. ECG revealed abnormal ST elevation in leads V1 to V3 during a paced rhythm. Multifocal premature ventricular contractions followed by ventricular fibrillation were documented. Saddleback-type ST elevation was confirmed after a mode change to AAI. The diagnosis of Brugada syndrome was made, and the DDD pacemaker was upgraded to an implantable cardioverter defibrillator. Brugada syndrome can be easily overlooked if the classic ECG findings are not initially noted but may be observed even during pacing therapy.

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Section: Discussionmentioning

confidence: 99%

Manifestation of Brugada Syndrome After Pacemaker Implantation in a Patient with Sick Sinus Syndrome

Nakazato

Suzuki

Yasuda

et al. 2004

Cardiovasc electrophysiol

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“…2,3 ST elevation with flecainide use can in fact be associated with a Brugada like pattern as in our case. 3,4 Previous studies have suggested that flecainide can induce a new Brugada ECG pattern or can unmask a Brugada syndrome by inducing a type 1 Brugada pattern in patients with pre-existing type 2 or type 3 Brugada patterns. 3e5 Druginduced Brugada pattern can be generally seen at standard therapeutic dose of flecainide and such patients may have a possible underlying genetic predisposition (like SCN5A mutations) causing abnormality of native sodium channel activity.…”

Section: Discussionmentioning

confidence: 99%

Brugada pattern masquerading as ST-segment elevation myocardial infarction in flecainide toxicity

Chhabra

Spodick

2012

Indian Heart Journal

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Flecainide (a class 1c antiarrhythmic) produces a dose-dependent decrease in intracardiac conduction. Its well known common electrocardiographic effects are prolongation of PR and QT intervals and the QRS complex duration. We report a case of flecainide toxicity in an elderly female who presented with a type 1 Brugada pattern who essentially had a previously normal ECG pattern on therapeutic dose of flecainide therapy. The case describes a rare electrocardiographic abnormality induced by flecainide toxicity which otherwise could be easily misinterpreted as a ST-segment elevation myocardial infarction (STEMI) without lack of expertise and high clinical suspicion.

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“…In those cases, administration of a sodium channel blocker and changes in autonomic balance may unmask the ECG pattern. Intravenous ajmaline, flecainide or procainamide accentuate ST segment elevation, while beta-adrenergic stimulation normalizes the ECG (3,7,8,10,11).…”

Section: Discussionmentioning

confidence: 99%

Anaesthesia in patients with Brugada syndrome

Kim

Park

Min

et al. 2004

Acta Anaesthesiol Scand

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Brugada syndrome is characterized by right bundle branch block, ST segment elevation in the precordial leads and sudden death caused by ventricular fibrillation. We present two successful anaesthetic management cases in patients with Brugada syndrome. Accepted for publication 8 May 2004Key words: Brugada syndrome; complications; electrocardiography; sudden death.# Acta Anaesthesiologica Scandinavica 48 (2004) I N 1992 a new syndrome was described consisting of syncope or sudden death in patients with a structurally normal heart and an electrocardiogram (ECG) characteristic of right bundle branch block with ST segment elevation in leads V 1 to V 3 . This condition was named 'Brugada syndrome' (1). The syndrome is genetically determined and caused by mutations in the gene SCN5A on chromosome 3, encoding the human cardiac sodium channel (2).There are few reports of anaesthetic management of patients with Brugada syndrome, and especially regional anaesthesia of patients with Brugada syndrome. Therefore, we report one case of regional anaesthesia and one case of general anaesthesia in patients with Brugada syndrome. Case report Case 1A 33-year-old man was presented for an emergency orthopaedic operation due to open fracture of the patella. One year ago, before admission, Brugada syndrome was diagnosed in routine cardiologic evaluation. He had no past history of syncope and there was no family history of sudden death. On admission, a physical examination revealed no abnormal findings except ECG findings showing the coved-type ST segment elevation in leads V 1 to V 3 with a right bundle branch block (Fig. 1). Echocardiography showed a normal heart with an ejection fraction of 60%. Electrophysiology study revealed normal sinus node function, but non-sustained ventricular tachycardia was induced by electric ventricular stimulation.Having been informed of the associated risks, the patient was taken to the operating room and routine monitors were applied. A radial arterial cannula was inserted under local anaesthetic. Prior to the induction of anaesthesia, an external defibrillator was prepared. Spinal tapping was carried out at the L4/5 space in right lateral position. Afterwards, 0.5% bupivacaine hydrochloride 10 mg was injected intrathecally and satisfactory spinal block was achieved up to the T 10 dermatome.During the operation, ECG and continuous blood pressure were monitored and showed no abnormalities.After a 2-h operation, the patient was transferred to the post anaesthetic care unit (PACU) and postoperative pain was controlled with intravenous patientcontrolled analgesia (PCA) using opioids and NSAID. Postoperative recovery was uneventful. Case 2A 56-year-old male with L 1 vertebral body compression fracture scheduled for spine fusion under general anaesthesia. His preoperative 12-lead ECG showed a complete right bundle branch block and ST segment elevation (Fig. 2). There was no family history of sudden death. Several years ago, before admission, he had one history of syncope attack. Echocardiogram showed no s...

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ST segment elevation in the right precordial leads following administration of class Ic antiarrhythmic drugs

Cited by 11 publications

References 13 publications

Manifestation of Brugada Syndrome After Pacemaker Implantation in a Patient with Sick Sinus Syndrome

Manifestation of Brugada Syndrome After Pacemaker Implantation in a Patient with Sick Sinus Syndrome

Brugada pattern masquerading as ST-segment elevation myocardial infarction in flecainide toxicity

Anaesthesia in patients with Brugada syndrome

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