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Published on: September 20, 2024
Brugada pattern in a patient medicated with lamotrigine
Rita Rodrigues1, Pedro Amador, Leandro Rassi
1Serviço de Cardiologia, Centro Hospitalar de Setúbal, EPE - Hospital de São Bernardo, Setúbal, Portugal.
Summary
Lamotrigine, an antidepressant, may induce a Brugada pattern in electrocardiograms by blocking sodium channels. Discontinuation of lamotrigine reversed this effect, suggesting a link between the drug and Brugada pattern expression.
Area of Science:
- Cardiology
- Clinical Electrophysiology
- Pharmacology
Background:
- Brugada syndrome is a genetic disorder affecting ion channels in the heart.
- Antidepressants can have cardiac side effects, including effects on ion channels.
- Electrocardiogram (ECG) abnormalities can indicate underlying cardiac conditions.
Observation:
- A 52-year-old woman on lamotrigine presented with precordial pain and ECG changes suggestive of Brugada pattern.
- Cardiac catheterization showed normal coronary arteries, ruling out acute coronary syndrome.
- Serial ECGs and a flecainide test confirmed a Brugada-like pattern.
Findings:
- Discontinuation of lamotrigine led to the reversal of the typical Brugada ECG pattern.
- Lamotrigine, a sodium channel blocker, may unmask or induce the Brugada pattern.
- The drug's mechanism of action on sodium channels is implicated in the observed ECG changes.
Implications:
- Clinicians should consider lamotrigine as a potential cause of Brugada pattern in patients with relevant symptoms.
- Further research is needed to understand the precise relationship between lamotrigine and Brugada syndrome.
- This case highlights the importance of medication review in patients presenting with unexplained ECG abnormalities.
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