Brugada pattern exposed with administration of amiodarone during emergent treatment of ventricular tachycardia

Brugada pattern is a well-known pathological finding on electrocardiogram (ECG) which increases the likelihood of cardiac arrest due to ventricular arrhythmia. These cases generally present in younger patients without evidence of an electrolyte abnormality, structural heart disease, or cardiac ischemia. In many instances, this pattern is either hidden on initial presentation or presents as an incidental finding on an EKG. Often times the Brugada syndrome leads to sudden cardiac death or more rarely can be unmasked with a class 1A or 1C anti-arrhythmic agent. Here, we present a distinctive case in which the pattern was exposed by amiodarone during the emergent treatment of Ventricular Tachycardia (VT).

A 34-year-old female, without significant cardiac history, presented to the Emergency Department after multiple near syncopal episodes at home. Initial ECG showed VT vs. SVT. After a failed trial of adenosine, the patient was treated with 150 mg amiodarone and became hypotensive needing an electrical cardioversion. After becoming bradycardic, the amiodarone drip was discontinued and she was admitted to the MICU. An echocardiogram and left heart catheterization showed no evidence of coronary artery disease or decreased ejection fraction. The patient's ECG now showed a subtle Brugada Type 3 pattern and she received a dual chamber AICD upon discharge.

This case emphasizes the awareness needed to seek out this pattern on subsequent ECG's. With the high lethality of Brugada, the emergency physician must recognize that multiple drugs can evoke this pattern after initial presentation.