Type 1 Brugada Pattern Associated with Nicotine Toxicity

Ondrejka, Jason; Giorgio, Gary

doi:10.1016/j.jemermed.2015.08.008

Cited by 9 publications

(2 citation statements)

References 17 publications

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“…Alcohol intoxication has been shown to induce the Brugada ECG pattern primarily by increasing parasympathetic nervous system activity and inhibiting I Ca currents [85]. Other drugs such as cocaine, nicotine and cannabis have also been associated with the Brugada pattern, with cocaine specifically blocking I Na : The mechanism underlying nicotine and cannabis are still unclear [89][90][91].…”

Section: External Influences That Trigger Brugadamentioning

confidence: 99%

Brugada syndrome

Korlipara¹,

Korlipara

Pentyala³

2020

Acta Cardiologica

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Brugada syndrome (BrS) is an inherited cardiac arrhythmia syndrome that causes a heightened risk for ventricular tachyarrhythmias and sudden cardiac death. BrS is characterised by a coved ST-segment elevation in right precordial leads. The prevalence is estimated to range between 1 in 5,000 to 1 in 2,000 in different populations, with the highest being in Southeast Asia and in males. More than 18 genes associated with BrS have been discovered and recent evidence has suggested a complex polygenic mode of inheritance with multiple common and rare genetic variants acting in concert to produce the BrS phenotype. Diagnosis of BrS in patients currently relies on presentation with a type-1 Brugada pattern on ECG either spontaneously or following a drug provocation test using a sodium channel blocker. Risk assessment in patients diagnosed with BrS is controversial, especially with regard to the predictive value of programmed electrical stimulation and novel ECG parameters, such as QRS fragmentation. The first line of BrS therapy remains an implantable cardioverter defibrillator (ICD), although radiofrequency catheter ablation has been shown to be an effective option in patients with contraindications for an ICD. True BrS can be unmasked on ECG in susceptible individuals by monitoring factors such as fever, and this has been recently evident in several patients infected with the 2019 novel coronavirus (COVID-19). Aggressive antipyretic therapy and regular ECG monitoring until fever resolves are current recommendations to help reduce the arrhythmic risk in these COVID-19 patients. In this review, we summarise the current knowledge on the epidemiology, pathophysiology, genetics, clinical diagnosis, risk stratification and treatment of patients with BrS, with special emphasis on COVID-19 comorbidity.

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Section: External Influences That Trigger Brugadamentioning

confidence: 99%

Brugada syndrome

Korlipara¹,

Korlipara

Pentyala³

2020

Acta Cardiologica

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“…Among 16 smokers undergoing electrophysiological study, exposure to cigarette smoke produced a statistically significant shortening of the sinus cycle length after chemical denervation of the sinus node with β-blockers and atropine [235]. In a single case report of mild nicotine toxicity, a young smoker presented with a typ1 Brugada pattern, raising the possibility of sodium channel blockade [236]. Nicotine has proved to be arrhythmogenic in animals and cell preparations;…”

Section: Acute Exposure To Smoking (Nicotine and Non-nicotine Constitmentioning

confidence: 99%

The effects of nicotine and cigarette smoking on cardiac electrophysiology.

Irfan¹

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collaboration, and contribution to projects related to this dissertation. This work would not have been possible without the administrative and financial support of Marshall University's Departments of Cardiology and Clinical Translational Services. I am especially grateful to research coordinators, Melissa Marcum and Scott Wiley, for their perseverance and unwavering commitment to this research study. I am greatly indebted to, and honored by, the encouragement and guidance from Dr. Christian Mueller, who introduced me to cardiovascular research and helped take the first steps of my scientific pursuits. Lastly, I thank my dear family, especially my mother, father, brother, sister, and wife for their enduring love, support, and sacrifice.

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Nicotine at clinically relevant concentrations affects atrial inward rectifier potassium current sensitive to acetylcholine

Bébarová

Matejovič

Švecová

et al. 2017

Naunyn-Schmiedeberg's Arch Pharmacol

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Nicotine abuse is associated with variety of diseases including arrhythmias, most often atrial fibrillation (AF). Altered inward rectifier potassium currents including acetylcholine-sensitive current I are known to be related to AF pathogenesis. Since relevant data are missing, we aimed to investigate I changes at clinically relevant concentrations of nicotine. Experiments were performed by the whole cell patch clamp technique at 23 ± 1 °C on isolated rat atrial myocytes. Nicotine was applied at following concentrations: 4, 40 and 400 nM; ethanol at 20 mM (∼0.09%). Nicotine at 40 and 400 nM significantly activated constitutively active component of I with the maximum effect at 40 nM (an increase by ∼100%); similar effect was observed at -110 and -50 mV. Changes at 4 nM nicotine were negligible on average. Coapplication of 40 nM nicotine and 20 mM ethanol (which is also known to activate this current) did not show cumulative effect. In the case of acetylcholine-induced component of I, a dual effect of nicotine and its correlation with the current magnitude in control were apparent: the current was increased by nicotine in the cells showing small current in control and vice versa. The effect of 40 and 400 nM nicotine on acetylcholine-induced component of I was significantly different at -110 and -50 mV. We conclude that nicotine at clinically relevant concentrations significantly increased constitutively active component of I and showed a dual effect on its acetylcholine-induced component, similarly as ethanol. Synchronous application of nicotine and ethanol did not cause additive effect.

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Type 1 Brugada Pattern Associated with Nicotine Toxicity

Cited by 9 publications

References 17 publications

Brugada syndrome

Brugada syndrome

The effects of nicotine and cigarette smoking on cardiac electrophysiology.

Nicotine at clinically relevant concentrations affects atrial inward rectifier potassium current sensitive to acetylcholine

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