Ranolazine-Induced Type 1 Brugada Pattern

Background: Brugada syndrome (BrS) is a rare inherited arrhythmia disease carrying a variable risk of sudden cardiac death. Diagnosis requires the type 1 Brugada electrocardiographic pattern, which can either be spontaneous or induced by sodium channel-blocking drugs. Ranolazine is an antianginal drug acting on the late sodium current with emerging antiarrhythmic properties; no information is available on the safety of ranolazine use in patients with BrS. Case Summary: We present the case of a 48-year-old man with recent history of ST-elevation myocardial infarction and residual microvascular angina who developed a type 1 Brugada pattern after starting therapy with ranolazine. Discussion: Ranolazine has been demonstrated to be effective as an antiarrhythmic drug in several conditions in which other sodium-channel blockers are currently employed (eg, atrial fibrillation and type 3 long QT syndrome). Given the mechanism of action, it is plausible to hypothesize a potential role of ranolazine in unmasking the type 1 Brugada pattern. Take-Home Messages: Evidence of the safety of ranolazine in patients with BrS is lacking. A possible connection between ranolazine assumption and the unmasking of a type 1 Brugada pattern may question its use in these patients.