Intravenous administration of class I antiarrhythmic drug induced T wave alternans in an asymptomatic Brugada syndrome patient

Pacing Clin Electrophysiol. 2003 Sep;26(9):1900-3. doi: 10.1046/j.1460-9592.2003.00288.x.

Abstract

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.

MeSH terms

  • Amiodarone / therapeutic use
  • Anti-Arrhythmia Agents / pharmacology*
  • Anti-Arrhythmia Agents / therapeutic use
  • Bundle-Branch Block / physiopathology*
  • Cardiac Pacing, Artificial
  • Electrocardiography* / drug effects
  • Electrophysiologic Techniques, Cardiac*
  • Humans
  • Lidocaine / analogs & derivatives*
  • Lidocaine / pharmacology*
  • Male
  • Middle Aged
  • Signal Processing, Computer-Assisted
  • Syndrome
  • Ventricular Fibrillation / physiopathology*

Substances

  • Anti-Arrhythmia Agents
  • Lidocaine
  • pilsicainide
  • Amiodarone