锂诱发的Brugada综合征的暴露
Unmasking of brugada syndrome by lithium.
作者信息
Darbar Dawood, Yang Tao, Churchwell Keith, Wilde Arthur A M, Roden Dan M
机构信息
Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, TN 37232-6602, USA.
出版信息
Circulation. 2005 Sep 13;112(11):1527-31. doi: 10.1161/CIRCULATIONAHA.105.548487. Epub 2005 Sep 6.
BACKGROUND
The characteristic ECG pattern of ST-segment elevation in V1 and V2 in the Brugada syndrome is dynamic; it is often intermittently present in affected individuals and can be unmasked by sodium channel blockers, including antiarrhythmic drugs and tricyclic antidepressants. We report here 2 patients who developed the Brugada ECG pattern after administration of lithium, a commonly used drug not previously reported to block cardiac sodium channels.
METHODS AND RESULTS
Lithium induced transient ST-segment elevation (type 1 Brugada pattern) in right precordial leads at therapeutic concentrations in 2 patients with bipolar disorder. Lithium withdrawal in the patients resulted in reversion to type 2 or 3 Brugada patterns or resolution of ST-T abnormalities. In Chinese hamster ovary cells transfected with SCN5A, which encodes the cardiac sodium channel, lithium chloride caused concentration-dependent block of peak INa at levels well below the therapeutic range (IC50 of 6.8+/-0.4 micromol/L).
CONCLUSIONS
The widely used drug lithium is a potent blocker of cardiac sodium channels and may unmask patients with the Brugada syndrome.
背景
Brugada综合征患者V1和V2导联ST段抬高的特征性心电图表现是动态变化的；在受影响个体中常间歇性出现，并且可被包括抗心律失常药物和三环类抗抑郁药在内的钠通道阻滞剂所揭示。我们在此报告2例患者，他们在服用锂盐后出现了Brugada心电图表现，锂盐是一种常用药物，此前未被报道可阻断心脏钠通道。
方法与结果
2例双相情感障碍患者在治疗浓度下，锂盐诱导右胸前导联出现短暂性ST段抬高（1型Brugada图形）。患者停用锂盐后，心电图恢复为2型或3型Brugada图形或ST-T异常消失。在转染了编码心脏钠通道的SCN5A的中国仓鼠卵巢细胞中，氯化锂在远低于治疗范围的浓度下引起峰值INa的浓度依赖性阻断（IC50为6.8±0.4 μmol/L）。
结论
广泛使用的药物锂盐是心脏钠通道的强效阻滞剂，可能会使Brugada综合征患者的心电图表现显现出来。
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