Lacosamide induced Brugada I morphology in the setting of septicemia

Abstract

Introduction: Brugada syndrome may be unmasked by non-antiarrhythmic pharmaceuticals or drugs. Lacosamide is an antiepileptic agent with a novel mechanism of sodium channel inhibition and has the potential to cause cardiac sodium channel blockade. Patient concerns: In this report, we describe the case of patient with a history of a seizure disorder who presented with Brugada I electrocardiogram morphology in the setting of septicemia. Diagnosis: Brugada I electrocardiogram morphology was unmasked by lacosamide antiepileptic monotherapy. Interventions: Lacosamide therapy was discontinued. Outcomes: Normalization of the electrocardiogram and resolution of Brugada morphology occurred on hospital day 1. Conclusion: Caution should be exercised in the use of lacosamide in those at risk for conduction delay, or in combination therapy with medications that impair renal clearance, metabolism of lacosamide, or that display inherent sodium channel blocking properties.

Case Report: Lacosamide unmasking SCN5A-associated Brugada syndrome in a young female with epilepsy

“…and feasibility with intravenous (IV) administration (2,3). Lacosamide also acts on cardiac sodium channels, which can potentially trigger cardiac arrhythmias, especially in patients who already have a predisposition, whether it be genetic, such as patients with Brugada syndrome (BrS), or of another type (4).…”