Brugada-like electrocardiographic pattern induced by lamotrigine toxicity

Area of Science:

• Cardiology
• Neurology
• Clinical Pharmacology

Background:

• Brugada syndrome is a genetic disorder affecting cardiac sodium channels, leading to sudden cardiac death.
• Certain medications can induce electrocardiographic (ECG) patterns mimicking Brugada syndrome.

Observation:

• A patient with epilepsy on lamotrigine presented with neurological symptoms and an ECG suggestive of Brugada pattern.
• Elevated serum lamotrigine levels were detected, prompting further investigation.

Findings:

• Lamotrigine, at toxic concentrations, demonstrated an effect on cardiac sodium channels, inducing a Brugada ECG pattern.
• This effect was reversible upon reduction of lamotrigine levels, with procainamide challenge becoming negative.

Implications:

• Clinicians must consider lamotrigine toxicity in patients presenting with Brugada ECG patterns, especially those with epilepsy.
• Toxic lamotrigine levels may pose a risk for ventricular dysrhythmias, necessitating careful monitoring.