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. 2001 Jan;85(1):e3. doi: 10.1136/heart.85.1.e3

ST segment elevation in the right precordial leads following administration of class Ic antiarrhythmic drugs

M Yasuda, Y Nakazato, H Yamashita, G Sekita, Y Kawano, Y Mineda, K Nakazato, T Tokano, M Sumiyoshi, Y Nakata
PMCID: PMC1729593  PMID: 11119481

Abstract

Electrocardiographic changes were evaluated retrospectively in five patients without previous episodes of syncope or ventricular fibrillation who developed abnormal ST segment elevation mimicking the Brugada syndrome in leads V1-V3 after the administration of class Ic antiarrhythmic drugs. Pilsicainide (four patients) or flecainide (one patient) were administered orally for the treatment of symptomatic paroxysmal atrial fibrillation or premature atrial contractions. The QRS duration, QTc, and JT intervals on 12 lead surface ECG before administration of these drugs were all within normal range. After administration of the drugs, coved-type ST segment elevation in the right precordial leads was observed with mild QRS prolongation, but there were no apparent changes in JT intervals. No serious arrhythmias were observed during the follow up periods. Since ST segment elevation with mild QRS prolongation was observed with both pilsicainide and flecainide, strong sodium channel blocking effects in the depolarisation may have been the main factors responsible for the ECG changes. As the relation between ST segment elevation and the incidence of serious arrhythmias has not yet been sufficiently clarified, electrocardiographic changes should be closely monitored whenever class Ic drugs are given.


Keywords: class Ic antiarrhythmic drugs; Brugada syndrome; ST segment elevation

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Figure 1  .

Figure 1  

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Case 1. (A) Sinus rhythm with premature atrial contraction (PAC) before drug treatment. (B) Four weeks after initiation of treatment with oral pilsicainide. ECG revealed abnormal ST segment elevation in leads V1-V3. (C) After discontinuation of pilsicainide ST segment elevation returned to normal.

Figure 2  .

Figure 2  

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Case 2. (Left strip) Paroxysmal atrial fibrillation (Paf). (Right strip) Two weeks after initiation of oral pilsicainide. ECG revealed atrial flutter with 2:1 atrioventricular conduction with pronounced ST segment elevation at leads V1-V3. Case 3. (Left strip) On the third day of acute anteroseptal myocardial infarction. ECG revealed sinus rhythm with abnormal Q wave and mild ST segment elevation in leads V1-V6 and I, aVL. Thereafter repeated Paf episodes were noted. (Right strip) Four days after initiation of pilsicainide. ECG exhibited pronounced ST segment elevation in leads V1-V3. After discontinuation of pilsicainide, a combination of oral verapamil and pirmenol effectively prevented the Paf and abnormal ST elevation was not recognised. In this case, left ventricular aneurysm and new ischaemic episodes such as chest pain and elevations in serum myocardial enzymes were not recognised during the ST segment elevation after administration of pilsicainide.

Figure 3  .

Figure 3  

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Case 4. (Left strip) Paf. (Middle strip) Four weeks after initiation of flecainide. Abnormal ST segment elevation in leads V1-V3 was observed. (Right strip) The ST segment elevation was somewhat improved by tapering down the flecainide to 100 mg daily, and then it returned to normal with the discontinuation of flecainide. In this case, the degree of ST segment elevation seemed to depend on the dose of flecainide. Case 5. (Left strip) Sinus rhythm. (Right strip) Two weeks after initiation of oral pilsicainide for the control of Paf. ECG revealed abnormal ST segment elevation in leads V1-V3. In this case, oral cibenzoline effectively prevented Paf and no ST segment elevation was noted with its administration.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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