Although class 1A and 1C antiarrhythmic agents have been used to identify concealed Brugada syndrome, lidocaine, also used as a local anaesthetic, does not. Similarly, Mexiletine, a class 1B sodium channel blocker, has not been reported to induce Brugada ECG. On the other hand, exposure to the long-acting local anaesthetic, bupivacaine, has been reported to induce the ECG manifestations of Brugada syndrome and ventricular tachycardia in an otherwise silent carrier of an SCN5A mutation. The mutation was shown to reduce the sodium current on whole-cell patch-clamping. In another report, a patient developed the type 1 ECG pattern after receiving a continuous epidural bupivacaine infusion. After withdrawal of bupivacaine, the ECG changes reverted back to baseline.
Unlike lidocaine, bupivacaine causes greater depression of the rapid phase of depolarization in Purkinje fibres and ventricular muscle and remains bound to the sodium channels for a longer period of time. This may explain its ability to induce arrhythmia in patients with concealed Brugada syndrome.
Europace. 2009;11(8):989-994. © 2009
Cite this: Drug-induced Brugada Syndrome - Medscape - Aug 01, 2009.