Acquired Type 1 Brugada Syndrome Induced by Chronic High-Dose Kratom Use

Kratom denotes the naturally occurring alkaloids found in Mitragyna speciosa and is self-administered for the treatment of chronic pain, anxiety, and opioid withdrawal. Kratom is cardiotoxic with several case reports linking its use to QTc prolongation and ventricular dysrhythmias; however, there exist few reports of kratom-induced Brugada syndrome. A 36-year-old male with a past medical history inclusive of polysubstance abuse, bipolar disorder, and seizure disorder presented to the emergency department for chest pain. The patient reported a three-week history of lightheadedness when standing, oftentimes accompanied by palpitations and syncope. The patient was prescribed lamotrigine but reported non-adherence for more than three months due to a lack of insurance. The patient self-administered high-dose (~100 grams/day) white vein kratom daily for the last three years for symptoms of opioid withdrawal and alcohol cravings. He denied a family history of sudden cardiac death. The initial electrocardiogram (EKG) demonstrated coved ST segments followed by a negative T wave in leads V1 and V2 consistent with a type 1 Brugada pattern. Pacer pads were applied, and cardiology and electrophysiology were consulted. The patient was admitted to the medical intensive care unit on telemetry. Serial EKGs returned to normal sinus rhythm, and an inpatient flecainide challenge was negative, making Brugada syndrome secondary to chronic high-dose kratom use the most likely diagnosis. We presented a case of type 1 Brugada syndrome induced by chronic high-dose kratom use. While the clinical management of kratom toxicity is mostly supportive, physicians should consider potentially fatal cardiac dysrhythmias including Brugada syndrome.