Brugada-Type Electrocardiographic Changes Induced by Long-Term Lithium Use

A 49-year-old man presented to the emergency depart- ment with a 3-month history of increasing ataxia, tremors, and slurred speech.He had a history of bipolar disorder that required lithium, carbamazepine, and risperidone therapy for mood modulation.A serum lithium level measurement was performed and was found to be 2.5 mmol/L (therapeutic range 0.8 to 1.2 mmol/L).There was no history of suicidal ideation, recent medication changes, improper medication administration, recent volume depletion, or renal insufficiency.There was no family history consistent with sudden cardiac death.A 12-lead ECG showed normal sinus rhythm at a rate of 64 bpm, with a normal axis, a prolonged corrected QT interval of 479 ms, and a pseudo right bundle-branch block pattern consistent with a type 1 Brugada pattern (Figure 1).The patient was managed conservatively with discontinuation of the lithium, intravenous hydration, and serial lithium level measurements and ECGs.The ECGs showed gradual resolu-Figure 1. Twelve-lead ECG showing Brugada type 1 pattern with corresponding lithium level of 2.7 mmol/L.