Brugada electrocardiographic pattern elicited by cyclic antidepressants overdose
Wilma E Monteban-Kooistra1, Maarten P van den Berg1, Jaap E Tulleken2
1Intensive & Respiratory Care Unit (ICB), Dept. Cardiology, University Medical Center Groningen, 30.001, 9700 RB, Groningen, Netherlands.
Intensive Care Medicine
|January 25, 2006
Summary
Tricyclic antidepressant (TCA) poisoning can cause Brugada pattern electrocardiograms (ECGs), a sign of intraventricular conduction disturbances. Early recognition of these ECG changes is crucial for diagnosing TCA toxicity when the substance is unknown.
Area of Science:
- Cardiology
- Toxicology
- Emergency Medicine
Background:
- Brugada syndrome is a genetic disorder linked to sudden cardiac death.
- Brugada pattern electrocardiograms (ECGs) can be induced by certain drug toxicities, including tricyclic antidepressants (TCAs).
- TCA toxicity often necessitates critical care admission and management.
Purpose of the Study:
- To retrospectively analyze the characteristics and ECG indicators of TCA toxicity.
- To investigate the prevalence and significance of Brugada pattern ECGs in TCA-poisoned patients.
Main Methods:
- Retrospective analysis of patients admitted to the ICU for deliberate self-poisoning between 2000 and 2004.
- ECG analysis by a cardiologist to identify abnormalities and Brugada patterns.
- Categorization of TCA-poisoned patients into groups based on ECG findings.
Main Results:
- Of 35 TCA-poisoned patients, 17% (6 patients) exhibited a Brugada-like ECG pattern.
- Increased QRS duration (>100 ms) was observed in 37% of TCA patients.
- ECG abnormalities resolved rapidly with sodium bicarbonate; Brugada pattern group had higher APACHE II scores and bicarbonate use.
Conclusions:
- The Brugada pattern ECG in TCA poisoning represents intraventricular conduction disturbances.
- Identifying these conduction disturbances aids in suspecting TCA poisoning when the causative agent is unknown.
- Early recognition of ECG abnormalities is vital for managing TCA toxicity.
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