(Circulation. 2000;102:945.)
© 2000 American Heart Association, Inc.
Brief Rapid Communications |
The Elusive Link Between LQT3 and Brugada Syndrome
The Role of Flecainide Challenge
From the Department of Molecular Cardiology (S.G.P., C.N., E.R.), Fondazione Salvatore Maugeri, IRCCS, Pavia, Italy, and the Department of Cardiology (S.G.P., C.N., P.J.S., R.B., L.C.), University of Pavia and Policlinico S. Matteo, Istituto di Ricovero e Cura a Carattere Scientifico, Pavia, Italy.
Correspondence to Silvia G. Priori, MD, PhD, Director of Molecular Cardiology, Fondazione Salvatore Maugeri, Via Ferrata 8, 27100 Pavia, Italy. E-mail spriori{at}fsm.it
Background—Defects of the SCN5A gene encoding the cardiac sodium channel are associated with both the LQT3 subtype of long-QT syndrome and Brugada syndrome (BS). The typical manifestations of long-QT syndrome (QT interval prolongation) and BS (ST segment elevation in leads V1 through V3) may coexist in the same patients, which raises questions about the actual differences between LQT3 and BS. Intravenous flecainide is the standard provocative test used to unmask BS in individuals with concealed forms of the disease, and oral flecainide has been proposed as a treatment option for LQT3 patients because it may shorten their QT interval.
Methods and Results—We tested the possibility that in some LQT3
patients, flecainide might not only shorten the QT interval, but also
produce an elevation of the ST segment. A total of 13 patients from 7
LQT3 families received intravenous flecainide using the
protocol used for BS. As expected, QT, QTc, JT, and JTc interval
shortening was observed in 12 of the 13 patients, and concomitant ST
segment elevation in leads V1 through V3 (
2 mm) was observed in
6 of the 13.
Conclusions—The data demonstrate that flecainide may induce ST segment elevation in LQT3 patients, raising concerns about the safety of flecainide therapy and demonstrating the existence of an intriguing overlap between LQT3 and BS.
Key Words: long-QT syndrome • Brugada syndrome • arrhythmia • drugs
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