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ST Segment Elevation in the Right Precordial Leads Induced with Class IC Antiarrhythmic Drugs
Author(s) -
FUJIKI AKIRA,
USUI MASAHIRO,
NAGASAWA HIDEHIKO,
MIZUMAKI KOICHI,
HAYASHI HIDEKI,
INOUE HIROSHI
Publication year - 1999
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.1999.tb00662.x
Subject(s) - flecainide , medicine , procainamide , brugada syndrome , cardiology , atrial flutter , propafenone , st segment , right bundle branch block , st elevation , quinidine , electrocardiography , atrial fibrillation , torsades de pointes , anesthesia , qt interval , myocardial infarction
ST Segment Elevation by Class IC Drugs. We evaluated two patients without previous episodes of syncope who showed characteristic ECG changes similar to Brugada syndrome following administration of Class IC drugs, flecainide and pilsicainide, but not following Class IA drugs. Patient 1 had frequent episodes of paroxysmal atrial fibrillation resistant to Class IA drugs. After treatment with flecainide, the ECG showed a marked ST elevation in leads V 2 , and V 3 , and the coved‐type configuration of ST segment in lead V 2 . A signal‐averaged ECG showed late potentials that became more prominent after flecainide. Pilsicainide, a Class IC drug, induced the same ST segment elevation as flecainide, but procainamide did not. Patient 2 also had frequent episodes of paroxysmal atrial fibrillation. Pilsicainide changed atrial flbrillation to atrial flutter with 2:1 ventricular response, and the ECG showed right bundle branch block and a marked coved‐type ST elevation in leads V 1 and V 2 . After termination of atrial flutter, ST segment elevation in leads V 1 and V 2/ continued. In this patient, procainamide and quinidine did not induce this type of ECG change. In conclusion, strong Na channel blocking drugs induce ST segment elevation similar to Brugada syndrome even in patients without any history of syncope or ventricular fibrillation.