Diphenhydramine Overdose and Brugada Sign

López-Barbeito, Beatriz; Lluís, Meritxell; Delgado, Victoria; Jiménez, Sònia; Dı́az-Infante, Ernesto; Nogué-Xarau, Santiago; Brugada, Josep

doi:10.1111/j.1540-8159.2005.00154.x

Cited by 39 publications

(10 citation statements)

References 11 publications

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“…López‐Barbeito et al reported a case where diphenhydramine overdose induced the characteristic coved type ST‐segment elevation of BrS in an unconscious and hypotensive patient without documented arrhythmias. However, flecainide failed to induce the same ECG abnormalities . On the contrary, in the case of an asymptomatic individual who developed the Brugada ECG phenotype during dimenhydrinate infusion, the ECG abnormality was reproduced later with intravenous flecainide .…”

Section: Brugada Ecg Pattern and Brsmentioning

confidence: 92%

Drug‐Induced Brugada Syndrome by Noncardiac Agents

Letsas

Kavvouras

Κόλλιας

et al. 2013

Pacing Clinical Electrophis

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Drug-induced Brugada syndrome (BrS) represents a great challenge for the prescribing clinicians as well as for those involved in the development of novel pharmaceuticals and in the regulatory bodies responsible with monitoring drug safety. Apart from well-known cardiac agents (mainly Class I antiarrhythmics), an increasing number of noncardiac agents, including psychotropic and anesthetic drugs, have been shown to induce the characteristic Brugada electrocardiogram pattern predisposing to fatal ventricular arrhythmias. Up to now, both repolarization and depolarization abnormalities are thought to be related to the development of ventricular fibrillation in BrS patients. This review highlights the mechanisms and the noncardiac medical agents that unmask a genetic predisposition to BrS.

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Section: Brugada Ecg Pattern and Brsmentioning

confidence: 92%

Drug‐Induced Brugada Syndrome by Noncardiac Agents

Letsas

Kavvouras

Κόλλιας

et al. 2013

Pacing Clinical Electrophis

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“…Other SSRIs, fluvoxamine (Stirnimann et al, 2010) and paroxetine (Bigwood et al, 2005) are also reported to unmask BrS ECG. Antihistaminic agents terfenadine (Di Diego et al, 2002), dimenhydrinate (Pastor et al, 2001) and diphenhydramine, (Lopez-Barbeito et al, 2005) through sodium channel blocking properties, precipitate BrS. It should be noted that tricyclic antidepressants, phenothiazines and antihistaminics have anticholinergic properties as well and would be expected to neutralize the Brugada phenotype;…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Drug-induced fatal arrhythmias: Acquired long QT and Brugada syndromes

Turker

Itoh

et al. 2017

Pharmacology & Therapeutics

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Since the early 1990s, the concept of primary "inherited" arrhythmia syndromes or ion channelopathies has evolved rapidly as a result of revolutionary progresses made in molecular genetics. Alterations in genes coding for membrane proteins such as ion channels or their associated proteins responsible for the generation of cardiac action potentials (AP) have been shown to cause specific malfunctions which eventually lead to cardiac arrhythmias. These arrhythmic disorders include congenital long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, short QT syndrome, progressive cardiac conduction disease, etc. Among these, long QT and Brugada syndromes are the most extensively studied, and drugs cause a phenocopy of these two diseases. To date, more than 10 different genes have been reported to be responsible for each syndrome. More recently, it was recognized that long QT syndrome can be latent, even in the presence of an unequivocally pathogenic mutation (silent mutation carrier). Co-existence of other pathological conditions in these silent mutation carriers may trigger a malignant form of ventricular arrhythmia, the so called torsade de pointes (TdP) that is most commonly brought about by drugs. In analogy to the drug-induced long QT syndrome, Brugada type 1 ECG can also be induced or unmasked by a wide variety of drugs and pathological conditions; so physicians may encounter patients with a latent form of Brugada syndrome. Of particular note, Brugada syndrome is frequently associated with atrial fibrillation whose therapeutic agents such as Vaughan Williams class IC drugs can unmask the dormant and asymptomatic Brugada syndrome. This review describes two types of drug-induced arrhythmias: the long QT and Brugada syndromes.

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“…The Group 2 drugs include antiarrhythmic drugs (amiodarone, cibenzoline, disopyramide, lidocaine, verapamil, and propranolol), psychotropic drugs (carbamazepine, cyamemazine, dosulepine, doxepin, fluoxetine, fluvoxamine, imipramine, maprotiline, paroxetine, perphenazine, phenytoin, and thioridazine), analgesics/ anesthetics (ketamine and tramadol), dimenhydrinate, diphenhydramine, edrophonium, indapamide, metoclopramide, and terfenadine 33 . All Group 2 drugs are all either confirmed or believed to possess sodium channel blocking effects 33 , 59–70 . There are also a number of antianginal drugs that may be associated with a Type‐1 ECG, 1,33 however, given the current lack of evidence on the existence and nature of this relationship, the issue was not explored in this article.…”

Section: Unmasking True Brugada Syndrome By Sodium Channel Blockers Imentioning

confidence: 99%

Brugada Phenocopy: New Terminology and Proposed Classification

Baranchuk

Nguyen

Ryu

et al. 2012

Noninvasive Electrocardiol

218

154

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Brugada syndrome is a channelopathy characterized on ECG by coved ST-segment elevation (≥2 mm) in the right precordial leads and is associated with an increased risk of malignant ventricular arrhythmias. The term Brugada phenocopy is proposed to describe conditions that induce Brugada-like ECG manifestations in patients without true Brugada syndrome. An extensive review of the literature identified case reports that were classified according to their suspected etiological mechanism. Future directions to learn more about these intriguing cases is discussed.

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Diphenhydramine Overdose and Brugada Sign

Cited by 39 publications

References 11 publications

Drug‐Induced Brugada Syndrome by Noncardiac Agents

Drug‐Induced Brugada Syndrome by Noncardiac Agents

Drug-induced fatal arrhythmias: Acquired long QT and Brugada syndromes

Brugada Phenocopy: New Terminology and Proposed Classification

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