Key result
Intravenous administration of the class Ic antiarrhythmic drug pilsicainide augmented ST-T elevation and induced visible ST-T alternans in an asymptomatic patient with Brugada syndrome.
Case Report (n=1)
No
Intravenous pilsicainide can induce T wave alternans in asymptomatic patients with Brugada syndrome.
Requires caution with pilsicainide challenge in Brugada syndrome; leaves open whether induced T-wave alternans predicts events.
A 53-year-old man with an abnormal ECG was referred to the Nihon University School of Medicine. The 12-lead ECG showed right bundle branch block and saddleback-type ST elevation in leads V1-V3 (Brugada-type ECG). Signal-averaged ECG showed positive late potentials. Double ventricular extrastimuli (S1: 500 ms, S2: 250 ms, S3: 210 ms) induced VF. Amiodarone (200 mg/day) was administered for 6 months and programmed ventricular stimulation was repeated. VF was induced again by double ventricular stimuli (S1: 600 ms, S2: 240 ms, S3: 170 ms). Intravenous administration of class Ic antiarrhythmic drug, pilsicainide (1 mg/kg), augmented ST-T elevation in leads V1-V3, and visible ST-T alternans that was enhanced by atrial pacing was observed in leads V2 and V3. Visible ST-T wave alternans disappeared in 15 minutes. However, microvolt T wave alternans was present during atrial pacing at a rate of 70/min without visible ST-T alternans.
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Ohkubo et al. (2003) conducted a case report in Brugada syndrome (n=1). Pilsicainide was evaluated on Induction of T wave alternans. Intravenous administration of the class Ic antiarrhythmic drug pilsicainide augmented ST-T elevation and induced visible ST-T alternans in an asymptomatic patient with Brugada syndrome.