Abstract
A febrile state may provoke a Brugada electrocardiogram (ECG) pattern and trigger ventricular tachyarrhythmias in susceptible individuals. However, the prognostic value of fever-induced Brugada ECG pattern remains unclear. We analyzed the clinical and extended long-term follow-up data of consecutive febrile patients with a type 1 Brugada ECG presented to the emergency department. A total of 21 individuals (18 males; mean age, 43.7 ± 18.6 years at diagnosis) were divided into symptomatic (resuscitated cardiac arrest in one, syncope in two) and asymptomatic (18, 86%) groups. Sustained polymorphic ventricular tachycardias were inducible in two patients with previous syncope. All 18 asymptomatic patients had no spontaneous type 1 Brugada ECG recorded at second intercostal space and no family history of sudden death. Among asymptomatic individuals, 4 had a total 12 of repeated non-arrhythmogenic febrile episodes all with recurrent type 1 Brugada ECGs, and none had a ventricular arrhythmic event during 116 ± 19 months of follow-up. In the symptomatic group, two had defibrillator shocks for a new arrhythmic event at 31- and 49 months follow-up, respectively, and one without defibrillator therapy died suddenly at 8 months follow-up. A previous history of aborted sudden death or syncope was significantly associated with adverse outcomes in symptomatic compared with asymptomatic individuals (log-rank p < 0.0001). In conclusion, clinical presentation or history of syncope is the most important parameter in the risk stratification of febrile patients with type 1 Brugada ECG. Asymptomatic individuals with a negative family history of sudden death and without spontaneous type 1 Brugada ECG, have an exceptionally low future risk of arrhythmic events. Careful follow-up with timely and aggressive control of fever is an appropriate management option.
Highlights
Brugada syndrome is a distinct arrhythmogenic genetic disorder characterized by an ECG pattern of coved-type ST-segment elevation in the right precordial leads (V1–V3) at an increased propensity for ventricular fibrillation and the risk of sudden cardiac death [1]
Consecutive patients admitted to a tertiary university hospital emergency department between May 2009 and May 2014 were screened by weekly review of ECG recordings and all consecutive febrile patients with a type 1 Brugada ECG pattern characterized by a right bundle branch block and a high take-off >2 mm coved ST-segment elevation, followed by a negative T wave in at least 2 right precordial leads (V1–V3) according to the Second Brugada Consensus Conference criteria [3] were included as the analytic sample
Sustained polymorphic ventricular tachycardia was induced from the right ventricular apex with up to triple extra-stimuli, and an implantable cardioverter-defibrillator (ICD) was implanted subsequently under the impression of Brugada syndrome during his index hospitalization
Summary
Brugada syndrome is a distinct arrhythmogenic genetic disorder characterized by an ECG pattern of coved-type ST-segment elevation in the right precordial leads (V1–V3) at an increased propensity for ventricular fibrillation and the risk of sudden cardiac death [1]. Conflicting study results on this association make it uncertain whether fever-induced Brugada ECG pattern bears any relation to the risk of sudden cardiac death. Some investigators have suggested that patients presenting with a Brugada ECG pattern are at considerably higher risk of sudden cardiac death and that Brugada ECG pattern should be considered a medical emergency [4,7] Opponents of this view argue that fever may cause a transient Brugada ECG pattern in susceptible patients who do not have the genetically defined syndrome [2]. The purpose of this study was to define the clinical relevance and evaluate the risk of ventricular arrhythmias associated with fever-induced Brugada ECG pattern in different clinical situations, and to present extended long-term follow-up data on clinical outcomes in the largest ever reported series of consecutive individuals with fever-induced Brugada ECG pattern
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