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. 2013 Sep;10(9):1375-82.
doi: 10.1016/j.hrthm.2013.07.030. Epub 2013 Jul 19.

Fever-induced Brugada pattern: how common is it and what does it mean?

Arnon Adler  1 , Guy Topaz, Karin Heller, David Zeltser, Tami Ohayon, Uri Rozovski, Amir Halkin, Raphael Rosso, Shay Ben-Shachar, Charles Antzelevitch, Sami Viskin
Affiliations

Fever-induced Brugada pattern: how common is it and what does it mean?

Arnon Adler et al. Heart Rhythm. 2013 Sep.

Abstract

Background: Fever is known to unmask the Brugada pattern on the electrocardiogram (ECG) and trigger ventricular arrhythmias in patients with Brugada syndrome. Genetic studies in selected cases with fever-induced Brugada pattern have identified disease-causing mutations. Thus, "fever-induced Brugada" is a recognized clinical entity. However, its prevalence has not been systematically evaluated.

Objective: The purpose of this study was to assess the prevalence of Brugada pattern in consecutive patients with fever.

Methods: ECGs of patients with fever admitted to the emergency department were evaluated for the presence of Brugada pattern and compared with ECGs of consecutive nonfebrile patients.

Results: ECGs of 402 patients with fever and 909 without were evaluated. Type I Brugada pattern was 20 times more common in the febrile group than in the afebrile group (2% vs. 0.1%, respectively, P = .0001). All patients with fever-induced type I Brugada pattern were asymptomatic and remained so during 30 months of follow-up.

Conclusion: Type I Brugada pattern is definitively more common among patients with fever, suggesting that asymptomatic Brugada syndrome is more prevalent than previously estimated.

Keywords: AIDS; Brugada syndrome; ECG; Fever; Ventricular fibrillation; acquired immunodeficiency syndrome; electrocardiogram.

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Figures

Figure 1
Figure 1
Representative ECGs of the 9 patients with type I Brugada pattern, including 8 patients with fever (shown with the temperature measured when their ECG was recorded) and 1 afebrile patient.
Figure 2
Figure 2
ECG of an asymptomatic patient (no. 2) recorded during febrile illness (temperature 39°C) (A), when afebrile (B), and during ajmaline test (C). During the ajmaline test, the precordial leads are positioned on the second and third intercostal spaces. The test was stopped after administration of only 0.45 mg/kg because of the immediate ST-segment elevation.
Figure 3
Figure 3
ECG of asymptomatic patient (no. 4) treated with clothiapine recorded during febrile illness (temperature 40°C) (A) and once more after the fever resolved (B). Of note, the dosage of clothiapine was the same at the time of both recordings.
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Comment in

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