Kratom Triggers Brugada Syndrome and Cardiac Arrest in Opioid Use Disorder Patient

Why it matters

This case demonstrates that kratom can unmask underlying Brugada Syndrome severe enough to cause cardiac arrest requiring CPR — a critical warning for patients using kratom to manage opioid cravings.

The big picture

With kratom increasingly used as an opioid substitute, this case shows it can cause life-threatening cardiac events in susceptible individuals; patients with Brugada Syndrome or family history of sudden cardiac death must avoid kratom.

Key findings

• • A 41-year-old male on opioid use disorder maintenance took 3 spoonfuls of kratom (triple his usual dose) and collapsed requiring 3 rounds of CPR
• • Initial ECG showed Type 1 Brugada Pattern; subsequent ECG resembled Type 2 pattern
• • Patient received an ICD; genetic panel showed no known Brugada mutations
• • Two of three lifetime syncopal episodes occurred in the setting of increased kratom use, strongly implicating kratom as trigger

What they say

Case report presented at ACC.23, University of New Mexico, Albuquerque; published in JACC Volume 81, Issue 8, 2023.

Bottom line

Kratom triggered cardiac arrest and Brugada Syndrome in a patient without known cardiac disease; the association between kratom and Brugada Syndrome carries life-threatening implications for susceptible users.