Brugada-Phenocopy Induced by Propafenone Overdose and Successful Treatment: A Case Report

Yıl 2017, Cilt: 34 Sayı: 5, 473 - 475, 01.09.2017

Mehmet Emre Arı Filiz Ekici

Öz

15-year-old girl having a seizure was brought to the emergency room. She took 1.5 g propafenone for suicidal intention. She had metabolic acidosis. Long QRS interval and ST elevation in leads V1 through V3 were seen on electrocardiography. Background: Brugada syndrome is an inherited arrhythmogenic disease that may cause sudden cardiac death due to ventricular fibrillation in young adults. Brugada syndrome caused by propafenone intoxication has been noted rarely in the literature. We report a rare case, Brugada phenocopy due to propafenone intoxication and its treatment. Case Report: A 15-year-old girl having a seizure was brought to the emergency room. She took 1.5 g propafenone (Rythmol, Abbott, Chicago, IL, USA) for suicidal intention. She had metabolic acidosis. Long QRS interval and ST elevation in leads V1 through V3 were seen on electrocardiography. After bicarbonate infusion for 4 hours, haemodynamic and neurologic findings were recovered, and all electrocardiography abnormalities disappeared. The Brugada-like electrocardiography pattern was not recognized in her surface and 24-hour Holter electrocardiography at follow-up. Ajmaline challenge test was negative 2 weeks later. Conclusion: Absence of symptoms and documented ventricular tachycardia, negative challenge test, and a negative family history demonstrated that the Brugada phenocopy was a transient finding in this case and related to propafenone intoxication.

Anahtar Kelimeler

Brugada-like electrocardiography pattern, propafenone, children, Brugada phenocopy

Kaynakça

• 1. Baranchuk A, Nguyen T, Ryu MH, Femenía F, Zareba W, Wilde AA, et al. Brugada phenocopy: new terminology and proposed classification. Ann Non-invasive Electrocardiol 2012;17:299-314.
• 2. Riera AR, Uchida AH, Schapachnik E, Dubner S, Filho CF, Ferreira C. Propofol infusion syndrome and Brugada syndrome electrocardiographic phenocopy. Cardiol J 2010;17:130-5.
• 3. Köppel C, Oberdisse U, Heinemeyer G. Clinical course and outcome in class IC antiarrhythmic overdose. J Toxicol Clin Toxicol 1990;28:433-44.
• 4. Brubacher J. Bicarbonate therapy for unstable propafenone-induced wide complex tachycardia. CJEM 2004;6:349-56.
• 5. Avci A, Yilmaz A, Celik M, Demir K, Keles F. Successful treatment of suicide attempt by megadose of propafenone and captopril. Cardiovasc Toxicol 2013;13:230-3.
• 6. Hasdemir C, Olukman M, Ulucan C, Roden DM. Brugada-type ECG pattern and extreme QRS complex widening with propafenone overdose. J Cardiovasc Electrophysiol 2006;17:565-6.
• 7. Junttila MJ, Gonzalez M, Lizotte E, Benito B, Vernooy K, Sarkozy A, et al. Induced Brugada-type electrocardiogram, a sign for imminent malignant arrhythmias. Circulation 2008;117:1890-3.
• 8. Hermida JS, Jandaud S, Lemoine JL, Rodriguez-Lafrasse C, Delonca J, Bertrand C, et al. Prevalence of drug-induced electrocardiographic pattern of the Brugada syndrome in a healthy population. Am J Cardiol 2004;94:230-3.