ST segment elevation in the right precordial leads induced with Class IC antiarrhythmic drugs: Insight into the mechanism of Brugada syndrome
ST segment elevation in the right precordial leads induced with Class IC antiarrhythmic drugs: Insight into the mechanism of Brugada syndrome
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DOI：
10.1111/j.1540-8167.1999.tb00662.x
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发表时间：
1999-02-01
影响因子：
2.7
通讯作者：
Inoue, H
中科院分区：
文献类型：
--
作者：
Fujiki, A;Usui, M;Inoue, H
IC类药物的ST段抬高。我们评估了2例既往无晕厥发作的患者，这些患者在使用IC类药物氟卡尼和匹西卡尼后显示出与Brugada综合征相似的特征性ECG变化，但在使用IA类药物后未显示。患者1频繁发作对IA类药物耐药的阵发性房颤。氟卡尼治疗后，心电图显示V-2和V-3导联ST段明显抬高，V-2导联ST段呈覆盖型构型。信号平均ECG显示，氟卡尼、Pilsicainide（一种IC类药物）诱导与氟卡尼相同的ST段抬高后，晚电位变得更加突出，但普鲁卡因胺没有。患者2也有阵发性房颤频繁发作，吡西卡尼将房颤改变为心房扑动，心室反应为2：1，ECG显示右束分支传导阻滞，V-1和V-2导联ST段明显覆盖型抬高。心房扑动终止后，V-1和V-2导联ST段持续抬高。在该患者中，普鲁卡因胺和奎尼丁未引起这种类型的ECG变化。总之，强钠通道阻滞剂诱导ST段抬高类似Brugada综合征，即使在患者没有任何晕厥或心室颤动的历史。
ST Segment Elevation by Class IC Drugs. We evaluated two patients without previous episodes of syncope who showed characteristic ECG changes similar to Brugada syndrome following administration of Class IC drugs, flecainide and pilsicainide, but not following Class IA drugs. Patient 1 had frequent episodes of paroxysmal atrial fibrillation resistant to Class IA drugs. After treatment with flecainide, the ECG showed a marked ST elevation in leads V-2 and V-3, and the coved-type configuration of ST segment in lead V-2. A signal-averaged ECG showed late potentials that became more prominent after flecainide, Pilsicainide, a Class IC drug, induced the same ST segment elevation as flecainide, but procainamide did not. Patient 2 also had frequent episodes of paroxysmal atrial fibrillation, Pilsicainide changed atrial fibrillation to atrial flutter with 2:1 ventricular response, and the ECG showed right bundle branch block and a marked coved-type ST elevation in leads V-1 and V-2. After termination of atrial flutter, ST segment elevation in leads V-1 and V-2 continued. In this patient, procainamide and quinidine did not induce this type of ECG change. In conclusion, strong Na channel blocking drugs induce ST segment elevation similar to Brugada syndrome even in patients without any history of syncope or ventricular fibrillation.