Amitriptyline-induced Brugada pattern fails to respond to sodium bicarbonate

Abstract

This report describes a Brugada electrocardiographic pattern after tricyclic antidepressant intoxication that fails to resolve following sodium bicarbonate treatment. A 50-year-old male ingested 13.6 grams of amitriptyline and presented in cardiopulmonary arrest. After initial resuscitation, the patient developed a Brugada electrocardiographic pattern. The pattern persisted despite intravenous administration of 700 mEq of sodium bicarbonate. Five hours after the last dose of sodium bicarbonate and 18 hours after initial presentation, the Brugada pattern resolved. No co-ingestants were ingested and an ischemic pattern was not seen on electrocardiogram. The serum amitriptyline level was >1000 ng/ml. Response of the tricyclic-induced Brugada pattern to sodium bicarbonate has not been previously reported.

Keywords :

• Brugada syndrome
• Tricyclic antidepressant
• Dysrhythmia
• Sodium bicarbonate

Notes

*Paper presented at North American Congress of Clinical Toxicology in Seattle, WA—September 2004, and at the American College of Emergency Physician's Government Services Chapter Joint Services Symposium in San Antonio, TX—March 2005.