Brugada Type I ECG Pattern after Flecainide Intoxication

Case Report

Austin J Clin Cardiolog. 2015; 2(2): 1039.

Brugada Type I ECG Pattern after Flecainide Intoxication

Schultinge L1,2*, Kuijper AFM1, Voogel AJ¹ and Oosterwerff E1,3

¹Department of Cardiology, Spaarne Hospital Hoofddorp, Netherland

²Department of Internal Medicine, Maastricht University, Netherland

³Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Netherland

*Corresponding author: Schultinge L, Department of Internal Medicine, Maastricht University, Prof. Oudlaan 13, 5707 KW Helmond

Received: May 14, 2015; Accepted: September 14, 2015; Published: October 01, 2015


Flecainide (a class 1c antiarrhythmic) is known for different electrocardiographic effects like prolongation of PR and QT intervals and the QRS complex duration. We report a case of Brugada syndrome, after flecainide intoxication in an elderly female who presented with a non-fatal suicide.

Methods: On admission the serum concentration of flecainide was tested. Several Electrocardiograms (ECG) were made. Six weeks after discharge and Ajmaline provocation test was performed.

Results: The serum concentration of flecainide measured was 2.90 mg/l (therapeutic range 0.45 – 0.90 mg/L, toxic effects are observed from 1 mg/L [1]. On the ECG, Brugada pattern type I was observed. In-hospital monitoring showed no abnormalities. Ajmaline provocation test was negative for Brugada.

Conclusion: We present a case of Brugada pattern, with the suggestion of a congenital Brugada syndrome, after flecainide overdose in a patient, with false-negative Ajmaline provocation test.

Keywords: Flecainide; Brugada; Intoxication


ECG: Electro Cardio Gram


Flecainide is a commonly used class IC antiarrhythmic agent that blocks sodium channels. It is mostly used for the treatment of supraventricular arrhythmias. Flecainide produces a dose-dependent decrease in intracardiac conduction [2]. It is known from several case reports that an overdose of flecainide causes changes in the ECG [3- 8]. we present a case with a Brugada type I pattern following flecainide overdose.

Case Report

A previously healthy 64-year old woman was presented in our hospital with a non-fatal suicide. After ingestion of 4000 mg of her husbands’ flecainide (slow release) she presented at the emergency department. The patient took four doses of 1000 mg slow release flecainide; the first dose 26 hours before admission and the last dose 12 hours before admission. She complained about dizziness, muscle weakness and nausea. She had vomited at home; no signs of the ingested medication were present in the vomit. Family history for sudden cardiac death was negative. Physical examination revealed no abnormalities with normal oxygen saturation and an arterial blood pressure of 130/80 mmHg. The ECG showed a Brugada type I pattern in V2. (Figure 1) The patient was admitted to the coronary care unit. Blood analysis revealed a mild kidney dysfunction (creatinine 116 umol/l; ref range 50 - 100 umol/l) with normal potassium concentration (4, 6 mmol/l; ref range 3.5 - 5.0 mmol/l) and normal calcium concentrations (2.42 mmol/l; ref range 2.10 - 2.60 mmol/l). Results of serum flecainide level were 2.90 ml/l (therapeutic range 0.45 – 0.90 mg/L) on admission. No further flecainide levels were measured. Because the patient was dehydrated due to vomiting, she was treated with intravenous sodium chloride 0.9%. No other medication was given. Subsequent ECGs (Figure 2) during admission showed a complete resolution in a couple of days. In-hospital monitoring showed no rhythm disturbances. After psychiatric assessment the patient was discharged from the hospital on the fourth day.