Brugada-Type Electrocardiographic Pattern Induced by Cocaine

Right bundle branch block with coved ST-segment elevation in leads VI through V 3 is the electrocardiographic (ECG) marker of the Brugada syndrome. We describe a healthy young man with a normal baseline ECG in whom a transient Brugada pattern was observed repeatedly after recreational cocaine use. Intravenous administration of procainamide and subsequent intravenous propranolol followed by noradrenaline failed to reproduce the Brugada sign. An electrophysiologic study performed in the presence of the Brugada ECG pattern showed no inducible arrhythmias. This case illustrates that, in susceptible individuals, cocaine may provoke the Brugada sign. The clinical importance of this cocaine-induced ECG abnormality is currently unknown.