Document Detail

Brugada-like electrocardiographic pattern induced by lamotrigine toxicity.
MedLine Citation:
PMID:  20864838     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Brugada syndrome, a recognized cause of sudden cardiac death, is due to a defect of cardiac sodium channels. Many pharmotherapeutic agents induce an electrocardiographic (ECG) pattern that can be confused with Brugada syndrome in patients who may not have the disease.
CASE PRESENTATION: A 22-year-old Hispanic female presented for emergency evaluation with ataxia and alterations in consciousness. Her medical history was significant for temporal lobe epilepsy, treated with lamotrigine, a phenyltriazine agent known to block neuronal voltage-gated sodium channels. There was no family history of sudden cardiac death. Initial laboratory data, neuroimaging, and echocardiography were unremarkable. Her ECG on presentation was concerning for Brugada pattern. Because of the nonspecific ECG finding, the patient underwent procainamide challenge, which was initially felt to be positive. Serum lamotrigine level was subsequently reported in the toxic range at 20.4 μg/mL (therapeutic range, 1-4 μg/mL). Repeated procainamide challenge was performed with lamotrigine levels below the therapeutic range (0.2 μg/mL) and failed to show diagnostic ECG changes.
CONCLUSIONS: Lamotrigine, at toxic levels, may lose specificity and exert an effect on cardiac sodium channels, a phenomenon that has not been previously described. Given previous reports of associations between the drug-induced Brugada ECG pattern and ventricular dysrhythmias, clinicians should be aware of this potential effect.
William J Strimel; Amy Woodruff; Peter Cheung; Batool F Kirmani; Shoei K Stephen Huang
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Clinical neuropharmacology     Volume:  33     ISSN:  1537-162X     ISO Abbreviation:  Clin Neuropharmacol     Publication Date:    2010 Sep-Oct
Date Detail:
Created Date:  2010-09-24     Completed Date:  2011-01-06     Revised Date:  2013-08-21    
Medline Journal Info:
Nlm Unique ID:  7607910     Medline TA:  Clin Neuropharmacol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  265-7     Citation Subset:  IM    
Section of Cardiac Electrophysiology and Pacing, Division of Cardiology, Scott and White Clinic, Department of Neurology, Scott and White Neuroscience Institute, Texas A&M University Health Science Center, Temple, TX, USA.
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MeSH Terms
Anticonvulsants / adverse effects*
Brugada Syndrome / chemically induced*,  physiopathology
Calcium Channel Blockers / adverse effects*,  blood
Epilepsy, Temporal Lobe / drug therapy
Procainamide / diagnostic use
Sodium Channels / drug effects
Triazines / adverse effects*,  blood
Withholding Treatment
Young Adult
Reg. No./Substance:
0/Anticonvulsants; 0/Calcium Channel Blockers; 0/Sodium Channels; 0/Triazines; 51-06-9/Procainamide; U3H27498KS/lamotrigine

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