Amitriptyline-induced Brugada pattern fails to respond to sodium bicarbonate

Clin Toxicol (Phila). 2007;45(2):186-8. doi: 10.1080/15563650600981186.


This report describes a Brugada electrocardiographic pattern after tricyclic antidepressant intoxication that fails to resolve following sodium bicarbonate treatment. A 50-year-old male ingested 13.6 grams of amitriptyline and presented in cardiopulmonary arrest. After initial resuscitation, the patient developed a Brugada electrocardiographic pattern. The pattern persisted despite intravenous administration of 700 mEq of sodium bicarbonate. Five hours after the last dose of sodium bicarbonate and 18 hours after initial presentation, the Brugada pattern resolved. No co-ingestants were ingested and an ischemic pattern was not seen on electrocardiogram. The serum amitriptyline level was >1000 ng/ml. Response of the tricyclic-induced Brugada pattern to sodium bicarbonate has not been previously reported.

Publication types

  • Case Reports

MeSH terms

  • Amitriptyline / blood
  • Amitriptyline / poisoning*
  • Antidepressive Agents, Tricyclic / blood
  • Antidepressive Agents, Tricyclic / poisoning*
  • Brugada Syndrome / chemically induced
  • Brugada Syndrome / drug therapy*
  • Brugada Syndrome / metabolism
  • Drug Overdose
  • Electrocardiography
  • Humans
  • Male
  • Middle Aged
  • Sodium Bicarbonate / administration & dosage
  • Sodium Bicarbonate / therapeutic use*
  • Sodium Channels / metabolism
  • Treatment Failure


  • Antidepressive Agents, Tricyclic
  • Sodium Channels
  • Amitriptyline
  • Sodium Bicarbonate