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

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.

Impact of clinical and genetic findings on the management of young patients with Brugada syndrome

“…Fever is known to associate with arrhythmic events 16 and unmask the type 1 ECG pattern 17 , which is 20 times more common in febrile patients 18 . In this study, fever triggered up to a quarter of all arrhythmic events.…”

Diagnostic Approach to Unexplained Cardiac Arrest (from the FIVI-Gen Study)

“…However, there is enough evidence of the risk of arrhythmia in probands with negative ECGs and unmasking tests. 4 [23][24][25] Genetic findings must be interpreted carefully, and largely in the same way as a molecular autopsy of a patient with a structurally normal heart who has died as a result of sudden cardiac arrest, where an ECG is not available. The value of a broad genetic test has been validated more in these cases than in survivors of UCA.…”

The Brugada ECG and Schizophrenia

“…The findings in the relatively small control groups studied here argue against this conclusion, but a recent survey reported the type 2 to 3 ECG pattern in 11.8% of male athletes and 9.9% of population controls, when V1 and V2 were recorded using the second intercostal space. 16 Another recent study highlighted the frequency (≈2%) with which the type 1 Brugada ECG pattern was seen in febrile patients in an emergency room setting, 17 again suggesting that the asymptomatic syndrome is commoner than previously appreciated.…”