Toxicidad por flecainida: aparición de signo de Brugada y bloqueo de rama izquierda
Resumen
Se trata de una paciente femenina de 47 años, que presentó episodio de taquicardia por reentrada intranodal y se inició tratamiento con flecainida, sin recurrencias. Luego de dos años de tratamiento presentó toxicidad por ese fármaco, que se manifestó eléctricamente con aparición de un bloqueo de rama izquierda y posteriormente del patrón convexo del sÃndrome de Brugada, cambios eléctricos que desaparecieron al suspender el antiarrÃtmico. Se realizó posteriormente ablación exitosa de la vÃa lenta del circuito de la arritmia.
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Referencias
Antzelevitch C, Yan GX. J-wave syndromes: Brugada and early repolarization syndromes. Heart Rhythm. 2015;12:1852-1866.
Priori SG S, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al. ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: death: the task force for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the ESC. Eur Heart J. 2015;36:2793-2867.
Priori S, Wilde A, Horie M, Cho Y, Behr E, Berul C, et al. HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Europace. 2013;15:1389-1406.
Issa Z, Miller J, Zipes D. Clinical arrhythmology and electrophysiology. A companion to Braunwald’s heart disease. Segunda ed. Saunders , editor. Philadelphia: Elsevier Saunders; 2012.
Page R, Joglar J, Caldwell M, Calkins H, Conti J, Deal B, et al. ACC/AHA/HRS Guideline for the management of adult patients with supraventricular tachycardia. J Am Coll Cardiol. 2016; 67(13):e27-115.
Yan G, Antzelevitch C. Cellular basis for the electrocardiographic J wave. Circulation. 1996;93:372-379.
Yan G, Antzelevich C. Cellular basis for the Brugada syndrome and other mechanisms of arrhythmogenesis associated with ST segment elevation. Circulation. 1999;100:1660-1666.
Antzelevitch C, Yan G. Cellular and ionic mechanisms responsible for the Brugada syndrome. J Electrocardiol. 2000; 3(Suppl):33-39.
Koncz I, Gurabi Z, Patocskai B, Panama B, Szel T, Hu D, et al. Mechanisms underlying the development of the electrocardiographic and arrhythmic manifestations of early repolarization syndrome. J Mol Cell cardiol. 2014;68C:20-28.
Stanley N, Bernard G, Opie L. Antiarrhythmic drugs and strategies. In Saunders , editor. Drugs for the heart. Philadelphia: Elsielver Saunders; 2013. 283-284.
Shimizu W, Antzelevitch C, Suyana K, Kurita T, Taguchi A, Aihara N, et al. Effect of sodium channel blockers on ST segment, QRS duration, and corrected QT interval in patients with Brugada syndrome. J Cardiovasc Electrophysiol. 2000;11:1320-1329.
Morita H, Morita S, Nagase S, Banba K, Nishii N, Tani Y, et al. Ventricular arrhythmia induced by sodium channel blocker in patients with Brugada syndrome. J Am Coll cardiol. 2003;42:1624-1631.
Valentino M, Panakos A, Ragupathi L, Williams J, Pavri B. Fleclainide toxicity: A case report and systematic review of its electrocardiographic patterns and management. Cardiovasc Toxicol. 2017;17:260-266.
Abdulrahman N, Elijah RB, Velislav NB. Electrocardiographic methods for diagnosis and risk stratification in the Brugada syndrome. J Saudi Heart Assoc. 2015;27:96-108.
Probst V, Veltmann C, Eckardt L, Meregalli PG, Gaita F, Tan HL, et al.. Long-term prognosis of patients diagnoses with Brugada syndrome: Results from the FINGER Brugada Syndrome Registry. Circulation. 2010;121:635-643.
Okamura H, Kamakura T, Morita H, Tokioka K, Nakajima I, Wada M, et al. Risk stratification in patients with Brugada syndrome without previous cardiac arrest – prognostic value of combined risk factors –. Circ J. 2015;79:310-317.
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