Brugada syndrome treatment
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
Lithium Treatment and Brugada Syndrome
Administration of Lithium can result in EKG manifestations of the Brugada syndrome. [1][2]. Syncope and sudden cardiac death have been observed in these patients.[3] The putative role of lithium has been suggested in so far as withdrawal of lithium results in either 1) normalization of the ECG or 2) conversion of the Brugada pattern to type 2 or 3. The appearance of Brugada type EKG patterns does not require toxic lithium levels.
Sodium Challenge
- Drugs that can be used
- Ajmaline 1 mg/kg/5 min IV
- Flecainide 2 mg/kg/10 min IV or 400 mg PO
- Procainamide 10 mg/kg/10 min IV
- Pilsicainide 1 mg/kg/10 min IV
- The sodium challenge should be terminated when
- Diagnostic Type 1 ST-segment elevation or Brugada ECG, develops
- ST segment in Type 2 increases by ≥2 mm
- Premature ventricular beats or other arrhythmias develop
- QRS widens to ≥130% of baseline
References
- ↑ Pirotte MJ, Mueller JG, Poprawski T. A case report of Brugada-type electrocardiographic changes in a patient taking lithium. Am J Emerg Med. 2008; 26: 113.
- ↑ Wright D, Salehian O. Brugada-Type Electrocardiographic Changes Induced by Long-Term Lithium Use. Circulation, FRCPC2010;122:e418-e419
- ↑ Laske C, Soekadar SR, Laszlo R, Plewnia C. Brugada syndrome in a patient treated with lithium. Am J Psychiatry. 2007; 164: 1440–1441.