Brugada Syndrome following Tricyclic Antidepressant Overdose

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.

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Brugada Syndrome: Fatal Consequences of a Must-Not-Miss Diagnosis

Critical Care Nurse ◽

10.4037/ccn2021499 ◽

2021 ◽

Vol 41 (5) ◽

pp. 15-22

Author(s):

L. Douglas Smith ◽

Sarah Gast ◽

Danielle F. Guy

Keyword(s):

At Risk ◽

Critical Care ◽

Sudden Cardiac Death ◽

Ventricular Arrhythmia ◽

Brugada Syndrome ◽

Cardiac Death ◽

Lifestyle Modification ◽

Genetic Disorder ◽

Cardiac Conduction ◽

St Segment Elevation

Background Brugada syndrome is a genetic disorder of cardiac conduction that predisposes patients to spontaneous ventricular arrhythmia and sudden cardiac death. Although Brugada syndrome is one of the most common causes of sudden cardiac death, patients presenting with the syndrome often go misdiagnosed. This error has potentially fatal consequences for patients, who are at risk for sudden cardiac death without appropriate management. Objective To increase the critical care professional’s knowledge of Brugada syndrome through detailed description of the characteristic electrocardiographic findings, an algorithmic approach to electrocardiogram evaluation, and a case report of a patient with a previously missed diagnosis of Brugada syndrome. The essential concepts of epidemiology, pathophysiology, clinical presentation, risk stratification, and management are reviewed for critical care professionals who may encounter patients with the syndrome. Diagnosis Patients typically present with syncope or cardiac arrest and an abnormal electrocardiographic finding of ST-segment elevation in the precordial leads. The diagnosis of Brugada syndrome centers on identification of its electrocardiographic characteristics by critical care professionals who routinely evaluate electrocardiograms. Critical care professionals, especially nurses and advanced practice nurses, should be proficient in recognizing the electrocardiographic appearance of Brugada syndrome and initiating appropriate management. Interventions Management strategies include prevention of sudden cardiac death through lifestyle modification and placement of an implantable cardioverter-defibrillator. Critical care professionals should be aware of commonly used medications that may exacerbate ventricular arrhythmia and place patients at risk for sudden cardiac death. Conclusion Increased awareness of Brugada syndrome among critical care professionals can decrease patient morbidity and mortality.

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Complications of tricyclic antidepressant overdose: identifying patients at risk

Reactions ◽

10.1007/bf03271050 ◽

1987 ◽

Vol 175 (1) ◽

pp. 2-2

Keyword(s):

At Risk ◽

Tricyclic Antidepressant ◽

Antidepressant Overdose ◽

Tricyclic Antidepressant Overdose ◽

Patients At Risk

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Brugada Syndrome Mimicked by Tricyclic Antidepressant Overdose

Journal of Cardiovascular Electrophysiology ◽

10.1046/j.1540-8167.2001.00275.x ◽

2001 ◽

Vol 12 (2) ◽

pp. 275-275 ◽

Cited By ~ 60

Author(s):

HIROSHI TADA ◽

CHRISTIAN STICHERLING ◽

HAKAN ORAL ◽

FRED MORADY

Keyword(s):

Brugada Syndrome ◽

Tricyclic Antidepressant ◽

Antidepressant Overdose ◽

Tricyclic Antidepressant Overdose

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BRUGADA PATTERN: AN UNUSUAL PRESENTATION OF TRICYCLIC ANTIDEPRESSANT OVERDOSE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(19)33272-3 ◽

2019 ◽

Vol 73 (9) ◽

pp. 2666

Author(s):

Diana Otero ◽

Persio Lopez ◽

Eder Cativo Calderon ◽

Joshua Kiss ◽

Steve Liao

Keyword(s):

Tricyclic Antidepressant ◽

Unusual Presentation ◽

Antidepressant Overdose ◽

Tricyclic Antidepressant Overdose ◽

Brugada Pattern

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Unmasking Brugada Syndrome with Oral Flecainide Provocation. A Case Series of Three Patients

Cardiology and Angiology An International Journal ◽

10.9734/ca/2019/v8i430108 ◽

2019 ◽

pp. 1-6

Author(s):

R. Singla ◽

A. Udyavar ◽

A. Gupta ◽

A. Bade ◽

K. Munde ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Brugada Syndrome ◽

Cardiac Death ◽

Challenge Test ◽

Sudden Cardiac Arrest ◽

Case Series ◽

St Segment Elevation ◽

Brugada Pattern

The present case series discuss three patients who had brugada type 2/ type 3 like ECG pattern that was converted to type 1 pattern with oral flecanide challenge test. Brugada syndrome is associated with a high incidence of sudden cardiac death, typical ECG pattern being ST-segment elevation in the right precordial leads with T wave inversion. Pharmacological provocation should only be performed when the baseline ECG is not diagnostic of Brugada Syndrome. PR prolongation in the baseline ECG is also a contraindication because of the risk of inducing AV block. Drug challenge is performed under strict monitoring of BP and 12-lead ECG and facilities for cardio version and resuscitation are available. Atypical RBBB pattern/type 2/3 Brugada pattern on ECG in patients of syncope or family history of sudden cardiac arrest is commonly encountered by a cardiologist. This can be performed to provoke type 1 brugada pattern on ECG. Diagnosed cases of Brugada may be treated with ICD with proper indication if needed and thus prevent sudden cardiac death.

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Researchers examine the risk factors for sudden cardiac death and management of at-risk patients

PsycEXTRA Dataset ◽

10.1037/e556542006-002 ◽

2002 ◽

Keyword(s):

Risk Factors ◽

At Risk ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Risk Patients

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Comparison of variant detection rate in genes between two cohorts of Czech living patients versus victims of sudden cardiac death with clinical / post mortem diagnosis of non-ischemic cardiomyopathy

European Heart Journal ◽

10.1093/ehjci/ehaa946.0338 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

E Borisincova ◽

P Votypka ◽

K Rucklova ◽

A Pilin ◽

M Kulvajtova ◽

...

Keyword(s):

At Risk ◽

Czech Republic ◽

Primary Prevention ◽

Sudden Cardiac Death ◽

Genetic Counselling ◽

Cardiac Death ◽

Detection Rate ◽

Funding Source ◽

Post Mortem ◽

Custom Made

Abstract Introduction Hereditary cardiomyopathy is associated with an increased risk of ventricular arrhythmia and sudden cardiac death (SCD). Genetic stratification substantiates risk assessment and enables the primary prevention of SCD in relatives at risk. We have analyzed the genetic aetiology of SCD in a representative Czech cohort with post mortem diagnosis of various forms of cardiomyopathy and compared it to living cases with these cardiac disorders. Patients and methods Between 2018 and 2019, altogether 47 victims of SCD with post mortem diagnosis of hypertrophic- (HCM; 18/47), arrhythmogenic- (ACM; 19/47) and dilated cardiomyopathy (DCM; 10/47) were identified. Concurrently, genetic testing was performed in 114 living patients (HCM 54/114, ACM 22/114, DCM 38/114). Genetic counselling and cardiologic examination had been carried out in first-degree relatives in all patients/SCD victims. Massively parallel sequencing (MiSeq platform; Illumina.com) was utilized for a custom-made panel comprising 100 candidate genes (Sophia Genetics, Switzerland). The presence of pathogenic variants was validated by Sanger DNA sequencing and through family segregation analyses. Results The causative detection rate (according to ACMG.net classes 4 or 5) in SCD victims with DCM was 60% (6/10) and in living patients with DCM 47.4% (18/38). Variants in TTN, RBM20, DES and FLNC (mainly truncating variants) prevailed in both groups. The detection rate in ACM was 5% (1/19 in SCN5A gene) in SCD victims and 31.8% (7/22) in living patients. Interestingly, the most prevalent mutated gene PKP2 in living patients was not detected in SCD victims. The detection rate in SCD victims with post mortem diagnosis of HCM was 16% (3/18) and in living patients 35% (19/54). The most prevalent gene was MYBPC3 in both groups, while PRKAG2 was detected in one SCD victim and in one living case who survived cardiac arrest. Conclusion Post-mortem genetic analysis in DCM yields a high detection rate and allows potentially effective primary prevention of SCD in relatives at risk. In contrast, the molecular autopsy of HCM and ACM renders a much lower yield which is below the mutation detection rate in living phenotype positive individuals. The results help to improve the genetic counselling in affected families in Czech Republic. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Ministry of Health of the Czech Republic

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Antidepressants and Risk of Sudden Cardiac Death: A Network Meta-Analysis and Systematic Review

Medical Sciences ◽

10.3390/medsci9020026 ◽

2021 ◽

Vol 9 (2) ◽

pp. 26

Author(s):

Narut Prasitlumkum ◽

Wisit Cheungpasitporn ◽

Nithi Tokavanich ◽

Kimberly R. Ding ◽

Jakrin Kewcharoen ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Mental Disorders ◽

Ventricular Arrhythmia ◽

Cardiac Death ◽

Selective Serotonin Reuptake Inhibitors ◽

Meta Analysis ◽

Tricyclic Antidepressant ◽

Systemic Review ◽

Analysis Model ◽

Antidepressant Use

Background: Antidepressants are one of the most prescribed medications, particularly for patients with mental disorders. Nevertheless, there are still limited data regarding the risk of ventricular arrhythmia (VA) and sudden cardiac death (SCD) associated with these medications. Thus, we performed systemic review and meta-analysis to characterize the risks of VA and SCD among patients who used common antidepressants. Methods: A literature search for studies that reported risk of ventricular arrhythmias and sudden cardiac death in antidepressant use from MEDLINE, EMBASE, and Cochrane Database from inception through September 2020. A random-effects model network meta-analysis model was used to analyze the relation between antidepressants and VA/SCD. Surface Under Cumulative Ranking Curve (SUCRA) was used to rank the treatment for each outcome. Results: The mean study sample size was 355,158 subjects. Tricyclic antidepressant (TCA) patients were the least likely to develop ventricular arrhythmia events/sudden cardiac deaths at OR 0.24, 0.028–1.2, OR 0.32 (95% CI 0.038–1.6) for serotonin and norepinephrine reuptake inhibitors (SNRI), and OR 0.36 (95% CI 0.043, 1.8) for selective serotonin reuptake inhibitors (SSRI), respectively. According to SUCRA analysis, TCA was on a higher rank compared to SNRI and SSRI considering the risk of VA/SCD. Conclusion: Our network meta-analysis demonstrated the low risk of VA/SCD among patients using antidepressants for SNRI, SSRI and especially, TCA. Despite the relatively lowest VA/SCD in TCA, drug efficacy and other adverse effects should be taken into account in patients with mental disorders.

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