Frequency of Brugada type ECG pattern in male subjects with fever

Abstract

Fever is considered as one of the implicated factors for Brugada type ECG pattern (BTEP). Numerous case reports highlighted the association of feverwith Brugada syndrome (BS) because certain subjectswith high fever displayed BTEP and experienced sudden cardiac death or ventricular arrhythmias [1–5]. However, there is still a lack of prospective data about the true frequency of BTEP among subjects with fever. ECG is usually not recorded in an otherwise healthy noncardiac patientwho comes inwith fever. If an ECGof a subjectwith fever is recorded, it is usually because of either an arrhythmic event or chest pain. Therefore, the aim of the present study was to determine the true frequency of BTEP in male subjects with fever by recording ECGs at standard and high right intercostal spaces (ICS). BetweenMay and December 2011, male subjects with fever (n=210) who presented to the emergency department were evaluated for study enrollment. Feverwasdefinedas a single body temperaturemeasurement of ≥38.3 °C (101.0 °F) or a body temperature of 38.0–38.2 °C (100.4– 100.9 °F) persistent for 1 h by tympanic thermometer probe. Subjects with any known cardiac and metabolic disorder as well as electrolyte abnormality, history of syncope and/or arrhythmia, bundle branch block and/or atrial fibrillation on ECG, family history of SCD and subjects who disclosedanykindof drugor substanceusewerenot included in the study. After exclusion 103 male subjects with fever were prospectively and consecutively included in the study. After the body temperature was measured, ECGs were recorded during febrile state at standard lead locations and also placing the right precordial (V1–3) leads at the 3rd and 2nd ICS. Subsequently, oral paracetamol was administered and cold compress was applied for alleviating fever. If the body temperature was b38.0 °C (100.4 °F), the subjects were considered to be afebrile. After a waiting period of 30 min during the afebrile state, ECGs were again recorded with the same order and technique. Twelve-lead surface ECGs were obtained from all subjects in a supine position at a paper speed of 25 mm/s and a calibration of 10 mm/mV. Electrocardiograms were obtained by the same investigator with the same ECG recorder (Nihon Kohden ECG-9020K, Japan). All ECG sampleswithout knowingwhich one was recorded during the febrile state were then blindly evaluated by two independent reviewers for the presence of BTEP according to the Second BrugadaConsensusConference criteria [1]. The studyprotocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki as reflected in a priori approval by the institution's human research committee. Written informed consent was obtained from all subjects. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology. The age, body