Brugada-Phenocopy Induced by Propafenone Overdose and Successful Treatment: A Case Report

Background: Brugada syndrome is an inheritedarrhythmogenic disease that may cause sudden cardiacdeath due to ventricular fibrillation in young adults.Brugada syndrome caused by propafenone intoxicationhas been noted rarely in the literature. We report arare case, Brugada phenocopy due to propafenoneintoxication and its treatment.Case Report: A 15-year-old girl having a seizurewas brought to the emergency room. She took 1.5 gpropafenone (Rythmol, Abbott, Chicago, IL, USA) forsuicidal intention. She had metabolic acidosis. Long QRSinterval and ST elevation in leads V1 through V3 wereseen on electrocardiography. After bicarbonate infusionfor 4 hours, haemodynamic and neurologic findings wererecovered, and all electrocardiography abnormalitiesdisappeared. The Brugada-like electrocardiographypattern was not recognized in her surface and 24-hourHolter electrocardiography at follow-up. Ajmalinechallenge test was negative 2 weeks later.Conclusion: Absence of symptoms and documentedventricular tachycardia, negative challenge test, and anegative family history demonstrated that the Brugadaphenocopy was a transient finding in this case andrelated to propafenone intoxication.

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1. Baranchuk A, Nguyen T, Ryu MH, Femenía F, Zareba W, Wilde AA, et al. Brugada phenocopy: new terminology and proposed classification. Ann Non-invasive Electrocardiol 2012;17:299-314.
2. Riera AR, Uchida AH, Schapachnik E, Dubner S, Filho CF, Ferreira C. Propofol infusion syndrome and Brugada syndrome electrocardiographic phenocopy. Cardiol J 2010;17:130-5.
3. Köppel C, Oberdisse U, Heinemeyer G. Clinical course and outcome in class IC antiarrhythmic overdose. J Toxicol Clin Toxicol 1990;28:433-44.
4. Brubacher J. Bicarbonate therapy for unstable propafenone-induced wide complex tachycardia. CJEM 2004;6:349-56.
5. Avci A, Yilmaz A, Celik M, Demir K, Keles F. Successful treatment of suicide attempt by megadose of propafenone and captopril. Cardiovasc Toxicol 2013;13:230-3.
6. Hasdemir C, Olukman M, Ulucan C, Roden DM. Brugada-type ECG pattern and extreme QRS complex widening with propafenone overdose. J Cardiovasc Electrophysiol 2006;17:565-6.
7. Junttila MJ, Gonzalez M, Lizotte E, Benito B, Vernooy K, Sarkozy A, et al. Induced Brugada-type electrocardiogram, a sign for imminent malignant arrhythmias. Circulation 2008;117:1890-3.
8. Hermida JS, Jandaud S, Lemoine JL, Rodriguez-Lafrasse C, Delonca J, Bertrand C, et al. Prevalence of drug-induced electrocardiographic pattern of the Brugada syndrome in a healthy population. Am J Cardiol 2004;94:230-3.