This case highlights the potential for antiarrhythmic drugs like cibenzoline, used during electrophysiological studies, to unmask asymptomatic Brugada syndrome and increase vulnerability to ventricular fibrillation.
Cibenzoline may unmask Brugada pattern during EP studies; hypothesis-generating for VF risk assessment in accessory pathway ablation.
A 29-year-old man was referred for electrophysiological testing and radiofrequency ablation because of repeated episodes of palpitation over 2 years. A 12-lead electrocardiogram during sinus rhythm showed manifest Wolff-Parkinson-White syndrome and during palpitation showed narrow QRS tachycardia at a rate of 213 beats/min. Following successful radiofrequency ablation of the left anterolateral accessory pathway, sustained atrial fibrillation was induced by atrial extrastimulation. Cibenzoline (2 mg/kg body weight) was injected to terminate atrial fibrillation. ST-T segment elevation in the right precordial leads was observed following cibenzoline administration. Ventricular fibrillation was reproducibly induced by ventricular extrastimuli (S1: 600 ms, S2: 220 ms, S3: 210 ms).
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Ohkubo et al. (2004) studied this question.
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