Brugada Syndrome Unmasked by Lithium

South Med J. 2009 Dec;102(12):1263-5. doi: 10.1097/SMJ.0b013e3181bfae69.

Abstract

A 38-year-old man was brought by emergency medical service after resuscitation following cardiac arrest. The patient was found pulseless with a wide complex tachycardia. The patient had bipolar disorder and was on lithium, lamotrigine, and ziprasidone. His electrolytes and lithium levels were normal. An electrocardiogram (EKG) was performed the next day and showed type 1 Brugada pattern. Lithium was held. Electrophysiologists made a diagnosis of drug-unmasked Brugada syndrome. Lithium can unmask Brugada syndrome through its ability to block sodium channels, even at subtherapeutic concentrations. Physicians need to be aware of this potentially fatal drug effect and should monitor EKGs of patients on lithium.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antimanic Agents / administration & dosage*
  • Antimanic Agents / adverse effects*
  • Bipolar Disorder / drug therapy
  • Brugada Syndrome / complications
  • Brugada Syndrome / diagnosis*
  • Cardiopulmonary Resuscitation
  • Drug Therapy, Combination
  • Electrocardiography
  • Heart Arrest / etiology*
  • Heart Arrest / therapy
  • Heart Conduction System / drug effects*
  • Humans
  • Lamotrigine
  • Lithium Compounds / administration & dosage*
  • Lithium Compounds / adverse effects*
  • Male
  • Piperazines / administration & dosage
  • Sodium Channel Blockers / administration & dosage
  • Sodium Channel Blockers / adverse effects
  • Thiazoles / administration & dosage
  • Triazines / administration & dosage

Substances

  • Antimanic Agents
  • Lithium Compounds
  • Piperazines
  • Sodium Channel Blockers
  • Thiazoles
  • Triazines
  • ziprasidone
  • Lamotrigine