The Brugada syndrome, a pro-arrhythmogenic repolarization abnormality, is becoming increasingly recognised as a cause of collapse and sudden cardiac death3. We report a case of a 48-year-old man with a tricyclic overdose and a delayed presentation of the Brugada pattern in the ICU. This case raises the need for clinicians to be aware of the Brugada pattern and those patients potentially at risk.
BrugadaP., BrugadaJ.Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical electrocardiographic syndrome: a multicentre report.J Am Coll Cardiol1992; 20: 1391–1396.
2.
WildeA.A, AntzelevitchC., BorggrefeM., BrugadaJ., BrugadaR., BrugadaP.Consensus Report: A proposed diagnostic criteria for the Brugada syndrome.Eur Heart J2002; 23: 1648–1654.
3.
AntzelevitchC., BrugadaP., BrugadaJ., BrugadaR., ShimizuW., GussakI.Brugada syndrome: a decade of progress.Circ Res2002; 91: 1114–1118.
4.
ChenQ., KirschG.E., AntzelevitchC., O'BrienR.E., Schulze-BahrE., KeatingM.T.Genetic basis and molecular mechanism for idiopathic ventricular fibrillation.Nature1998; 392: 293–296.
5.
WangQ., ShenJ., SplawskiI., AtkinsonD., LiZ., RobinsonJ.L.SCN5A mutations associated with an inherited cardiac arrhythmia, long QT syndrome.Cell1995; 80: 805–811.
6.
NagaseS., Fukushima KusanaK., Morita H+2 more et al. Epicardial electrogram of the right ventricular outflow tract in patients with the Brugada syndrome: using the epicardial lead.J Am Coll Cardiol2002; 39: 1992–1995.
TukkieR., Sogaard, VleugelsJ., de GrootI., WildeA., TanH.Delay in right ventricular activation contributes to Brugada syndrome.Circulation2004; 109: 1272–1277.
9.
PrioriS.G., NapolitanoC., GaspariniM., PapponeC., Della BellaP., GiordanoU.Natural history of Brugada syndrome: insights for risk stratification and management.Circulation2002; 105: 1342–1347.
10.
BrugadaJ., BrugadaR., BrugadaP.Determinants of sudden cardiac death in individuals with the electrocardiographic pattern of Brugada syndrome and no previous cardiac arrest.Circulation2003; 108: 3092–3096.
11.
NauC., SeaverM., WangS., WangG-K. Block of human heart hH1 sodium channels by amitriptyline.J Pharmacol Exp Ther1991; 256: 1072–1081.
12.
BabaliarosV.C., HurstJ.W.Tricyclic antidepressants and the Brugada syndrome: an example of Brugada waves appearing after the administration of desipramine.Clin Cardiol2002; 25: 395–398.
13.
Goldgran-ToledanoD., SiderisG., KevorkianJ.P.Overdose of cyclic antidepressants and the Brugada syndrome.N Engl J Med2002; 346: 1591–1592.
MatsuoK., AkahoshiM., SetoS., YanoK.Disappearance of the Brugada-type electrocardiogram after surgical castration: a role for testosterone and an explanation for the male preponderance.Pacing Clin Electrophysiol2003; 26: 1551–1553.
16.
MauryP., CoudercP., DelayM., BovedaS., BrugadaJ.Electrical storm in Brugada syndrome successfully treated using iso-prenaline.Europace2004; 6: 130–133.
17.
AhnJ., Willis HurstJ.Worrisome thoughts about the diagnosis and treatment of patients with brugada waves and the Brugada syndrome.Circulation2004; 109: 1463–1467.