Drug-induced Brugada Syndrome

Yee Guan Yap; Elijah R. Behr; A. John Camm

Disclosures

Europace. 2009;11(8):989-994. 

In This Article

Propofol

Propofol is the commonest anaesthetic used in modern medicine. It generally has few significant side effects. However, high doses of propofol infusion given for several days to patients with severe head injury had been reported to be associated with sudden death, a condition termed 'propofol infusion syndrome'.[66,67] The pathophysiological mechanism underlying this lethal effect remains unclear. In a retrospective study of 67 patients with head injury that received prolonged propofol infusion, seven had been identified as having propofol infusion syndrome.[68] Six of the propofol infusion syndrome patients developed the Brugada-like ECG and died within hours of irrecoverable electrical storm, whereas none of the 60 other patients developed ventricular arrhythmias, suggesting that the mechanism underlying the arrhythmogenesis in propofol infusion syndrome is similar to that responsible for ventricular arrhythmias in the Brugada syndrome.

Recently, an article by Junttila et al.[69] describing the poor prognosis associated with the acute induction of the Brugada type 1 ECG pattern. In particular, 11 of 26 patients with drug-induced changes suffered sudden and/or resuscitated cardiac death with the majority of these life-threatening cases being related to propofol infusion, whereas the rest were secondary to use of sodium channel blockers (antiarrhythmics and local anaesthetics). However, this series of patients probably represents a selected group and may not indicate the true spectrum and prognosis of the drug-induced Brugada ECG pattern. As discussed above, antidepressant overdoses appear to be the most commonly reported cause of the drug-induced Brugada ECG pattern, usually with an unremarkable event rate. A systematic, population-based, observational study of the condition will be necessary to understand the true significance of this presentation.

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