Section of Cardiology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
JAMA Intern Med. 2015 Dec;175(12):1951-4. doi: 10.1001/jamainternmed.2015.5934.
Cardiac arrhythmias are common causes of syncope. Brugada syndrome is an uncommon but serious genetic arrhythmia disorder that can be unmasked by medicines causing sodium channel blockade.
This report documents a case of Brugada syndrome and polymorphic ventricular tachycardia-ventricular fibrillation not initially recognized in a patient taking nortriptyline and experiencing syncope. It also illustrates one of the longest episodes of ventricular fibrillation recorded on an ambulatory monitor (94 seconds). Although the baseline electrocardiogram did not demonstrate a typical appearance for Brugada syndrome, provocative testing with flecainide in this patient with documented polymorphic ventricular tachycardia revealed a Brugada electrocardiogram pattern.
Vigilance should be maintained for arrhythmia substrates such as Brugada syndrome in patients with typical symptoms when they are prescribed membrane-active medicines. Long-term ambulatory rhythm monitors can provide useful information in these cases, especially when symptoms are infrequent.
心律失常是晕厥的常见原因。Brugada 综合征是一种不常见但严重的遗传性心律失常疾病，可被导致钠通道阻滞的药物诱发。
本报告记录了一例服用去甲替林并出现晕厥的 Brugada 综合征和多形性室性心动过速-心室颤动患者，最初未被识别。它还记录了动态监测器上记录到的最长心室颤动发作之一（94 秒）。尽管基线心电图未显示 Brugada 综合征的典型表现，但对该名已确诊多形性室性心动过速患者进行氟卡尼激发试验显示 Brugada 心电图模式。
当患者服用具有膜活性的药物出现典型症状时，应警惕 Brugada 综合征等心律失常底物。在这些情况下，长期动态心律监测器可提供有用信息，尤其是在症状不频繁时。
