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BMJ Case Rep. 2016 Jun 28;2016. pii: bcr2016214899. doi: 10.1136/bcr-2016-214899.

Type 1 Brugada pattern ECG due to supra-therapeutic phenytoin level.

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Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York, USA.
Head of Cardiology Department, Interfaith Medical Center, Brooklyn, New York, USA.


Brugada syndrome is an inherited arrhythmogenic disease, characterised by a coved-type ST segment elevation in right precordial leads and an increased risk of sudden cardiac death due to ventricular arrhythmia. To unmask or exacerbate a Brugada ECG pattern, class IA or IC antiarrhythmic agents are used, and clinicians can predict sudden cardiac death in a high-risk patient. However, phenytoin, one of the class IB agents, may induce a Brugada pattern ECG at a supra-therapeutic level and this association has rarely been reported. We describe a case of a patient with a phenytoin level about twice as high as the therapeutic level, which led to the emergence of a type 1 Brugada pattern ECG. Awareness should be made between this important association of supra-therapeutic phenytoin level and type 1 Brugada pattern ECG because symptomatic Brugada syndrome can lead to sudden cardiac death.

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