Referenced in: none

Automatically associated channels: Nav1.5

Title: Unmasking of brugada syndrome by lithium.

Authors: Dawood Darbar, Tao Yang, Keith Churchwell, Arthur A M Wilde, Dan M Roden

Journal, date & volume: Circulation, 2005 Sep 13 , 112, 1527-31

PubMed link: http://www.ncbi.nlm.nih.gov/pubmed/16144991

Abstract
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.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).The widely used drug lithium is a potent blocker of cardiac sodium channels and may unmask patients with the Brugada syndrome.