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Cibenzoline induced Brugada ECG pattern
Andrea Sarkozy1, Axel Caenepeel, Peter Geelen
1Cardiovascular Research and Teaching Institute, Aalst Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium. andreasarkozy@yahoo.ca
Summary
Oral cibenzoline, a sodium channel blocker, unmasked a Brugada ECG pattern in a patient. This antiarrhythmic drug should be avoided in patients diagnosed with Brugada syndrome.
Area of Science:
- Cardiology
- Electrophysiology
- Pharmacology
Background:
- Brugada syndrome is a genetic disorder characterized by abnormal electrocardiogram (ECG) findings and an increased risk of sudden cardiac death.
- Sodium channel blockers are commonly used antiarrhythmic drugs, but some can exacerbate Brugada syndrome.
- Identifying triggers that unmask Brugada ECG patterns is crucial for patient management.
Observation:
- A 61-year-old female presented with palpitations and an initial ECG showing incomplete right bundle branch block without ST elevation.
- The patient was treated with oral cibenzoline, a Class I sodium channel blocker.
- Following cibenzoline administration, the ECG revealed a diagnostic coved Brugada ECG (Type I) pattern.
Findings:
- The coved Brugada ECG pattern resolved upon discontinuation of cibenzoline.
- An ajmaline challenge test successfully reproduced the coved Brugada ECG pattern, confirming its association with sodium channel blockade.
- This is the first reported case of oral cibenzoline unmasking a Brugada ECG pattern in a patient with a previously normal baseline ECG.
Implications:
- Oral cibenzoline should be used with extreme caution, if at all, in patients with or suspected of having Brugada syndrome.
- Drug-induced Brugada ECG patterns highlight the importance of thorough medication review in patients presenting with relevant symptoms.
- Further research is warranted to elucidate the specific mechanisms by which cibenzoline affects cardiac sodium channels in Brugada syndrome.