JACC Case Report: Chronic Kratom Use Triggers Brugada Type 1 ECG Pattern and Arrhythmic Syncope

Why it matters

This peer-reviewed case adds to growing evidence that chronic, high-dose kratom use can unmask potentially fatal cardiac conditions, with critical implications for emergency physicians, cardiologists, and anyone experiencing unexplained fainting episodes.

The big picture

Brugada syndrome is a rare but potentially lethal inherited cardiac channelopathy characterized by ST elevation in leads V1–V3 and risk of sudden ventricular arrhythmias. While usually genetic, certain drugs and metabolic factors can reveal hidden Brugada patterns. Kratom alkaloids exhibit adrenergic and serotonergic properties, and in vitro studies suggest potassium channel inhibition that may explain proarrhythmic cardiac interactions.

Key findings

• A 43-year-old man using 6–7 kratom capsules daily for years presented with syncope and showed a Type 1 Brugada ECG pattern with >2mm ST elevation in V1–V2.
• Kratom alkaloids (mitragynine and 7-OH) exhibit opioid, adrenergic, and serotonergic activity; in vitro data suggest potassium channel inhibition and proarrhythmic potential.
• At least 4 published case reports now describe men with chronic high-dose kratom use who developed Brugada type 1 ECG changes, typically resolving after kratom cessation.
• The patient left against medical advice before ICD placement but was counseled to stop kratom and referred for electrophysiology follow-up.
• The study was published in JACC (Volume 87, Issue 13 Supplement) by researchers from Lehigh Valley Health Network/Jefferson Health.

What they say

The authors concluded: "This case adds to evidence that kratom can unmask Brugada syndrome. Careful review of supplement use is essential in patients with unexplained syncope and dynamic ECG changes."

Bottom line

Clinicians should routinely ask about kratom use in any patient with unexplained syncope or arrhythmia, as chronic use appears capable of triggering potentially fatal cardiac electrical disorders.