Brugada syndrome unmasked by fever: a comprehensive review of literature

Abstract

Background: The Brugada pattern is identified on the EKG by a coved ST-segment elevation accompanied by a negative T wave in the early precordial leads in the absence of a cardiac structural abnormality. Brugada pattern and Brugada syndrome should be differentiated, as the latter is associated with an increased risk of sudden cardiac death. Methods: The literature was searched using multiple databases to identify all the articles on Brugada pattern. Data were screened and analyzed by independent authors. Results: Sixty articles, comprising 71 patients, were included in the study. The mean age of patients was 42.6 years, with a higher prevalence of Brugada pattern in men (83%) than women (17%). The most frequent findings associated with Brugada pattern was fever (83%). Other less common presentations included cough (21%), sore throat (10%), syncope (18%), abdominal pain (8%), and chest pain (7%). Comorbidities included pneumonia (30%), upper respiratory tract infections (14%) and smoking (14%). Among treatment modalities, 39% of patients had ICD placement performed, 44% received antibiotics, while 14% had supportive care. Adenosine was given to 3% of patients, while other antiarrhythmics like milrinone, amiodarone, sotalol, procainamide, flecainide, and nitroglycerin were given to 1% of patients. Most patients with Brugada syndrome had a satisfactory outcome, with only 4% mortality rate(WHAT ABOUT THE OTHER 11%?). Out of the 71 patients, 3% had persistent Brugada patterns, while 86% of patients recovered completely. There was no significant effect of ICD on mortality or Brugada pattern resolution (p 0.37). Conclusion: Our study shows that fever is the main reason for unmasking the Brugada pattern in patients with this channelopathy. ICD placement in such patients is not recommended as it has no mortality benefits.

Novel insights in the pathomechanism of Brugada syndrome and fever‐related type 1 ECG changes in a preclinical study using human‐induced pluripotent stem cell‐derived cardiomyocytes

“… 37 In rabbit ischemic heart failure model, anti‐inflammation could increase the levels of Nav1.5 and decrease the inducibility of ventricular arrhythmia. 38 Inflammation has also been reported to unmask the ECG patterns and exacerbate the malignant ventricular arrhythmias in BrS, 12 , 14 but the exact roles and underlying mechanisms of inflammation in the arrhythmogenesis of BrS have not been explored so far. In our study, we used LPS to simulate inflammatory responses in cardiomyocytes.…”

“…Recent studies displayed the important role of inflammation in pathogenesis of BrS. 12 , 13 A case report study showed that two well‐characterized BrS patients with acute cardiac inflammation experienced frequently ventricular fibrillation episodes, which showed a possible cause of inflammation for the occurrence of malignant ventricular arrhythmias in BrS. 14 However, the exact roles and pathological mechanism of inflammation in BrS remain unclear.…”

“…Inflammation is one of the most common pathological states seen in human and is usually the culprit of fever. Recent studies displayed the important role of inflammation in pathogenesis of BrS 12,13 . A case report study showed that two well‐characterized BrS patients with acute cardiac inflammation experienced frequently ventricular fibrillation episodes, which showed a possible cause of inflammation for the occurrence of malignant ventricular arrhythmias in BrS 14 .…”

Sudden Cardiac Death—A New Insight Into Potentially Fatal Genetic Markers

“…Various triggers of Brugada syndrome are mentioned in the literature including fever, lithium, antidepressants, sodium channel blockers, and exercise (62)(63)(64). Therefore, diagnosis is difficult, and it is easy to overlook the existence of a Brugada pattern.…”

Novel SCN5A and GPD1L Variants Identified in Two Unrelated Han-Chinese Patients With Clinically Suspected Brugada Syndrome

“…The type 3 pattern includes a saddleback or coved pattern with ST-segment elevation <1 mm. Out of the three patterns in ECG, types 2 and 3 can convert to type 1 under the induction of sodium channel blockers, and only type 1 is diagnostic for BrS (11)(12)(13). Patients with BrS can have unexplained recurrent syncope, migraine, seizures, sleep disturbance, nocturnal agonal respiration, self-terminating polymorphic ventricular tachycardia, ventricular fibrillation (VF), inducibility of ventricular tachycardia with programmed electrical stimulation, and atrial arrhythmia, with a type 1 ECG pattern and sudden cardiac death (SCD) in family members (9,10,14,15).…”