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Ventricular arrhythmia induced by sodium channel blocker in patients with Brugada syndrome

Hiroshi Morita, MD^*,*, Shiho Takenaka Morita, MD^*, Satoshi Nagase, MD^*, Kimikazu Banba, MD^*, Nobuhiro Nishii, MD^*, Yoshinori Tani, MD^*, Atsuyuki Watanabe, MD^*, Kazufumi Nakamura, MD^*, Kengo Fukushima Kusano, MD^*, Tetsuro Emori, MD^*, Hiromi Matsubara, MD^*, Kazumasa Hina, MD, Toshimasa Kita, MD and Tohru Ohe, MD, FACC^*

^* Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama, Japan
Department of Cardiovascular Medicine, Cardiovascular Center Sakakibara Hospital, Okayama, Japan Okayama, Japan

View larger version (22K): [in a new window]   Figure 1 Pilsicainide-induced ventricular arrhythmia. (a) shows electrocardiogram (ECG) after administration of pilsicainide in case 3. A couplet of premature ventricular contraction (PVC) occurred, and QRS morphology of the PVC was left bundle branch block with inferior axis. (b) shows ECG after administration of pilsicainide in case 5. A triplet of PVC occurred, and QRS morphology of PVC was left bundle branch block with superior axis.

View larger version (21K): [in a new window]   Figure 2 Pilsicainide-induced ventricular tachycardia in case 9. (a) shows control electrocardiogram before administration of pilsicainide. (b) shows nonsustained polymorphic ventricular tachycardia immediately after administration of pilsicainide.

View larger version (71K): [in a new window]   Figure 3 Intracardiac electrogram during pilsicainide-induced ventricular tachycardia by an implantable cardioverter defibrillator in case 9. (a) Incessant polymorphic ventricular tachycardia occurred immediately after intravenous administration of pilsicainide. (b) Ventricular fibrillation occurred 7 h after injection of pilsicainide, and it was terminated by implantable cardioverter defibrillator therapy.

View larger version (26K): [in a new window]   Figure 4 Occurrence of T-wave alternans after administration of pilsicainide in case 4. (a) shows control electrocardiogram before administration of pilsicainide. (b) shows premature ventricular contraction (PVC) and manifest T-wave alternans in right precordial leads after administration of pilsicainide: PVC occurred on a deep inverted T wave. Arrows = larger inverted T wave in lead V2.

View larger version (12K): [in a new window]   Figure 5 Occurrence of T-wave alternans after administration of pilsicainide in case 9. (a) shows control electrocardiogram before administration of pilsicainide. (b) shows small but manifest T-wave alternans after administration of pilsicainide. Arrows = T waves of larger amplitude.