Bebarta Vikhyat S, Phillips Scott, Eberhardt Aaron, Calihan K J, Waksman Javier C, Heard Kennon
Division of Medical Toxicology, Department of Emergency Medicine, Wilford Hall Medical Center, San Antonio, Texas, USA.
Am J Cardiol. 2007 Aug 15;100(4):656-60. doi: 10.1016/j.amjcard.2007.03.077. Epub 2007 Jun 26.
Brugada syndrome is a genetic dysfunction of the myocardial sodium channel that leads to ventricular dysrhythmias. The electrocardiographic (ECG) pattern of Brugada syndrome is occasionally seen after tricyclic antidepressant (TCA) ingestion; however, the outcome and complication risk for these patients is not clear. The objective of our study was to describe the incidence of Brugada ECG pattern (BEP) and serious complications of these patients in a large case series of intentional TCA ingestions. We also compared the proportion of complications of patients with BEP versus those without BEP. We evaluated 402 TCA ingestions, of which 9 (2.3%) were associated with the development of BEP. We compared the adverse outcomes of all TCA ingestions versus TCA ingestions with BEP. A increase in the adverse outcomes in the BEP group was found: seizures (relative risk [RR] 4; 95% confidence interval [CI] 1.5 to 10.8), widened QRS (RR 4.8; 95% CI 1.8 to 12.9), and hypotension (RR 3.9; 95% CI 2.1 to 7.4). To reduce confounding ingestants, we also compared all patients with an isolated TCA ingestion versus those with BEP. A significant increase in adverse outcomes was again found with the BEP group: seizures (RR 3; 95% CI 1.1 to 8.6), widened QRS (RR 4.8; 95% CI 1.5 to 15.1), and hypotension (RR 3.4; 95% CI 1.9 to 22.3). No deaths or dysrhythmias were found in the BEP group. In conclusion, BEP after TCA ingestion is rare, and death or dysrhythmias did not occur. However, patients with BEP are likely at increased risk for TCA-induced complications.
Brugada综合征是一种导致心室心律失常的心肌钠通道基因功能障碍。三环类抗抑郁药(TCA)摄入后偶尔会出现Brugada综合征的心电图(ECG)表现;然而,这些患者的结局和并发症风险尚不清楚。我们研究的目的是在大量故意摄入TCA的病例系列中描述这些患者出现Brugada心电图表现(BEP)的发生率和严重并发症。我们还比较了有BEP的患者与无BEP的患者的并发症比例。我们评估了402例TCA摄入病例,其中9例(2.3%)出现了BEP。我们比较了所有TCA摄入病例与出现BEP的TCA摄入病例的不良结局。发现BEP组的不良结局有所增加:癫痫发作(相对风险[RR]4;95%置信区间[CI]1.5至10.8)、QRS波增宽(RR 4.8;95%CI 1.8至12.9)和低血压(RR 3.9;95%CI 2.1至7.4)。为了减少混杂的摄入物,我们还比较了单纯摄入TCA的所有患者与出现BEP的患者。再次发现BEP组的不良结局显著增加:癫痫发作(RR 3;95%CI 1.1至8.6)、QRS波增宽(RR 4.8;95%CI 1.5至15.1)和低血压(RR 3.4;95%CI 从1.9至22.3)。BEP组未发现死亡或心律失常。总之,TCA摄入后出现BEP很罕见,且未发生死亡或心律失常。然而,出现BEP的患者发生TCA诱导并发症的风险可能增加。