BACKGROUND: The characteristic ECG pattern of ST-segment elevation in V1 and V2 in the Brugada syndrome is dynamic; it is often intermittently present in affected individuals and can be unmasked by sodium channel blockers, including antiarrhythmic drugs and tricyclic antidepressants. We report here 2 patients who developed the Brugada ECG pattern after administration of lithium, a commonly used drug not previously reported to block cardiac sodium channels. METHODS AND RESULTS: Lithium induced transient ST-segment elevation (type 1 Brugada pattern) in right precordial leads at therapeutic concentrations in 2 patients with bipolar disorder. Lithium withdrawal in the patients resulted in reversion to type 2 or 3 Brugada patterns or resolution of ST-T abnormalities. In Chinese hamster ovary cells transfected with SCN5A, which encodes the cardiac sodium channel, lithium chloride caused concentration-dependent block of peak INa at levels well below the therapeutic range (IC50 of 6.8+/-0.4 micromol/L). CONCLUSIONS: The widely used drug lithium is a potent blocker of cardiac sodium channels and may unmask patients with the Brugada syndrome.
BACKGROUND: The characteristic ECG pattern of ST-segment elevation in V1 and V2 in the Brugada syndrome is dynamic; it is often intermittently present in affected individuals and can be unmasked by sodium channel blockers, including antiarrhythmic drugs and tricyclic antidepressants. We report here 2 patients who developed the Brugada ECG pattern after administration of lithium, a commonly used drug not previously reported to block cardiac sodium channels. METHODS AND RESULTS:Lithium induced transient ST-segment elevation (type 1 Brugada pattern) in right precordial leads at therapeutic concentrations in 2 patients with bipolar disorder. Lithium withdrawal in the patients resulted in reversion to type 2 or 3 Brugada patterns or resolution of ST-T abnormalities. In Chinese hamster ovary cells transfected with SCN5A, which encodes the cardiac sodium channel, lithium chloride caused concentration-dependent block of peak INa at levels well below the therapeutic range (IC50 of 6.8+/-0.4 micromol/L). CONCLUSIONS: The widely used drug lithium is a potent blocker of cardiac sodium channels and may unmask patients with the Brugada syndrome.
Authors: R Brugada; J Brugada; C Antzelevitch; G E Kirsch; D Potenza; J A Towbin; P Brugada Journal: Circulation Date: 2000-02-08 Impact factor: 29.690
Authors: Kevin Vernooy; Serge Sicouri; Robert Dumaine; Kui Hong; Antonio Oliva; Elena Burashnikov; Carl Timmermans; Tammo Delhaas; Harry J G M Crijns; Charles Antzelevitch; Luz-Maria Rodriguez; Ramon Brugada Journal: Heart Rhythm Date: 2006-07-07 Impact factor: 6.343
Authors: Syed Haseeb; Pramod Theetha Kariyanna; Apoorva Jayarangaiah; Ganesh Thirunavukkarasu; Sudhanva Hegde; Jonathan D Marmur; Sneha Neurgaonkar; Samy I McFarlane Journal: Am J Med Case Rep Date: 2018-10-07
Authors: Pieter G Postema; Christian Wolpert; Ahmad S Amin; Vincent Probst; Martin Borggrefe; Dan M Roden; Silvia G Priori; Hanno L Tan; Masayasu Hiraoka; Josep Brugada; Arthur A M Wilde Journal: Heart Rhythm Date: 2009-07-08 Impact factor: 6.343