Abstract 4119073: Zaza: A New Etiology of an Acquired Brugada-Pattern ECG

Introduction: Tianeptine, an unregulated supplement, adds a new problem to the ever-growing drug epidemic. We describe a case of Tianeptine overdose presenting with acute agitation and an acquired Brugada-pattern ECG. Case Description: A 26-year-old male presented with acute agitation after bystanders witnessed the patient ingest 15 capsules of “Zaza Silver”. Initial ECG showed a type I Brugada pattern with coved ST-elevations in V1 and prolonged QRS and QTc. Previous ECGs on record were negative for evidence of a hereditary Brugada pattern. His urine toxicology was positive for THC. Troponins, echocardiogram and CT head were unremarkable. The patient was treated with Diazepam and a sodium bicarbonate drip with close monitoring of arterial blood pH, maintaining a goal between 7.50-7.55. After resolution of his symptoms and ECG findings, he was discharged home. Discussion: Patients with a Brugada pattern ECG are at increased risk of fatal arrhythmias. Classified as both inherited and acquired, this unregulated supplement presents a new etiology of an acquired Brugada-pattern ECG. Tianeptine is a non-FDA approved tricyclic antidepressant that is marketed as a supplement under the brand name “Zaza” at gas stations and convenience stores. Currently approved for the treatment of depression in Europe, it is solely distributed in the US as an unregulated health supplement. We hypothesize that Tianeptiene’s Tricyclic Antidepressant properties can affect the myocardial voltage-gated sodium channels leading to the Brugada pattern on EKG with a similar mechanism as has been previously described in cases of Tricyclic Antidepressant overdoses. Early identification of EKG findings, coupled with a detailed history can be instrumental in early diagnosis and critical treatment with bicarbonate therapy. This case also demonstrates the dangers of the non-FDA marketing of tianeptine and underscores the urgent need to regulate such supplements.