JACC Case Report: Single Kratom Exposure Triggers Ventricular Fibrillation, Unmasks Brugada Syndrome in 28-Year-Old

Why it matters

This case demonstrates that even a single kratom exposure — not chronic use — may trigger life-threatening cardiac events in genetically susceptible individuals. Clinicians must be aware of kratom's potential to unmask hidden arrhythmia syndromes.

The big picture

Brugada syndrome is an inherited heart condition that can remain latent until triggered by certain drugs, fever, or electrolyte changes. Prior case reports linked kratom to Brugada patterns primarily through chronic, high-dose use. This new case from JACC shows one exposure may be enough to trigger cardiac arrest in susceptible individuals — raising the stakes for clinicians and public health officials alike.

Key findings

• A 28-year-old man went into cardiac arrest after smoking kratom for the first time
• Bystander CPR and two AED shocks restored circulation within 5 minutes
• ECG revealed a diagnostic type 1 Brugada pattern with characteristic coved ST-segment elevation
• No fever, electrolyte abnormalities, or other drugs (except benzodiazepines) were present
• Family history revealed sudden death of the patient's identical twin — indicating genetic susceptibility
• Mitragynine inhibits hERG potassium and voltage-gated sodium channels, mimicking known Brugada-provoking agents

What they say

The authors wrote: "This case demonstrates that even a single, nonchronic exposure may be sufficient to unmask BrS in genetically susceptible individuals... Clinicians should inquire about herbal and recreational substance use when evaluating unexplained cardiac arrest, particularly in the setting of a Brugada ECG pattern."

Bottom line

**Even one kratom exposure may trigger fatal cardiac arrhythmia in individuals with hidden Brugada syndrome — a risk that clinicians must screen for.**