Brugada syndrome ECG provoked by the selective serotonin reuptake inhibitor fluvoxamine

Stirnimann, Guido; Petitprez, Séverine; Abriel, Hugues; Schwick, Nicola Gillian (2010). Brugada syndrome ECG provoked by the selective serotonin reuptake inhibitor fluvoxamine. Europace, 12(2), pp. 282-283. Oxford: Oxford University Press 10.1093/europace/eup332

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A patient with an SCN5A p.W822X nonsense mutation, localized in the transmembrane region DII-S4 of the Na(v)1.5 sodium channel and leading to a non-expression of the mutant allele, was prescribed the selective serotonin reuptake inhibitor (SSRI) fluvoxamine (Floxyfral), 100 mg per day. His normal baseline ECG changed to a characteristic Brugada-Type-1-ECG pattern. To investigate whether fluvoxamine may reduce the cardiac sodium current, the effect of this drug was studied on the wild-type voltage-gated cardiac sodium channel Na(v)1.5 stably expressed in HEK293 cells. Patch-clamp recording showed a 50% inhibition of the current at a concentration of 57.3 microM. In our patient, no arrhythmia occurred but the proarrhythmic potential of SSRI in patients with SCN5A mutations cannot be excluded. Therefore, we advise 12-lead ECG control after administering SSRI in these patients.

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