| Brugada-like electrocardiographic pattern induced by lamotrigine toxicity. | |
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MedLine Citation:
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PMID: 20864838 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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William J Strimel; Amy Woodruff; Peter Cheung; Batool F Kirmani; Shoei K Stephen Huang |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Clinical neuropharmacology Volume: 33 ISSN: 1537-162X ISO Abbreviation: Clin Neuropharmacol Publication Date: 2010 Sep-Oct |
Date Detail:
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Created Date: 2010-09-24 Completed Date: 2011-01-06 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7607910 Medline TA: Clin Neuropharmacol Country: United States |
Other Details:
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Languages: eng Pagination: 265-7 Citation Subset: IM |
Affiliation:
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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. wstrimel@swmail.sw.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Anticonvulsants
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adverse effects* Brugada Syndrome / chemically induced*, physiopathology Calcium Channel Blockers / adverse effects*, blood Epilepsy, Temporal Lobe / drug therapy Female Humans Procainamide / diagnostic use Sodium Channels / drug effects Triazines / adverse effects*, blood Withholding Treatment Young Adult |
| Chemical | |
Reg. No./Substance:
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0/Anticonvulsants; 0/Calcium Channel Blockers; 0/Sodium Channels; 0/Triazines; 51-06-9/Procainamide; 84057-84-1/lamotrigine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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