Key result
A 40-year-old man treated with multiple psychotropic drugs, including nortriptyline, developed recurrent syncope and a Brugada-type ECG pattern, highlighting the difficulty in differentiating between concealed Brugada syndrome and drug-induced Brugada sign.
Case Report (n=1)
No
This case highlights the difficulty in differentiating between a concealed form of Brugada syndrome unmasked by antidepressants and a purely drug-induced Brugada sign, complicating the decision for ICD implantation.
Diagnostic uncertainty with psychotropic-induced Brugada patterns may affect ICD decisions; leaves differentiation from concealed syndrome open.
We describe a case of Brugada syndrome, in which recurrent syncope with convulsive seizures was induced after antidepressant treatment. The patient had been treated with five kinds of psychotropic drugs. The twelve-lead ECG after the syncope exhibited an RSR'-pattern in the precordial leads, however, a coved type ST-segment elevation was induced by a pilsicainide test. Although ventricular fibrillation was not induced in the electrophysiologic study, an ICD implantation was considered as the recommended therapy since Brugada syndrome unmasked by antidepressants could not be ruled out. The possible contribution of antidepressants to Brugada type ST-segment changes is discussed.
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Tashiro et al. (2009) conducted a case report in Brugada syndrome / Tricyclic Antidepressant-induced Brugada Sign (n=1). Psychotropic drugs (including nortriptyline) was evaluated. A 40-year-old man treated with multiple psychotropic drugs, including nortriptyline, developed recurrent syncope and a Brugada-type ECG pattern, highlighting the difficulty in differentiating between concealed Brugada syndrome and drug-induced Brugada sign.
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