Brugada-like Electrocardiographic Pattern Induced by Lamotrigine Toxicity

• DOI: 10.1097/wnf.0b013e3181e8ac66
• Publication Date: 2010-09-23T11:24:38Z
• Authors: William J. Strimel; Amy Woodruff; Peter Cheung; Batool F. Kirmani; Shoei K. Stephen ...
• Keywords: Procainamide; Sudden Death

Brugada syndrome, a recognized cause of sudden cardiac death, is due to defect sodium channels. Many pharmotherapeutic agents induce an electrocardiographic (ECG) pattern that can be confused with syndrome in patients who may not have the disease.A 22-year-old Hispanic female presented for emergency evaluation ataxia and alterations consciousness. Her medical history was significant temporal lobe epilepsy, treated lamotrigine, phenyltriazine agent known block neuronal voltage-gated There no family death. Initial laboratory data, neuroimaging, echocardiography were unremarkable. ECG on presentation concerning pattern. Because nonspecific finding, patient underwent procainamide challenge, which initially felt positive. Serum lamotrigine level subsequently reported toxic range at 20.4 μg/mL (therapeutic range, 1-4 μg/mL). Repeated challenge performed levels below therapeutic (0.2 μg/mL) failed show diagnostic changes.Lamotrigine, levels, lose specificity exert effect channels, phenomenon has been previously described. Given previous reports associations between drug-induced ventricular dysrhythmias, clinicians should aware this potential effect.