Electrocardiographic pattern of Brugada syndrome disclosed by a febrile illness: clinical and therapeutic implications

Abstract

The typical ECG phenotype of BS disclosed by a febrile illness confirms the in vitro experimental data that previously established a correlation between ECG pattern of BS and temperature variations. The clinical and therapeutic implications of these findings are discussed.

Concomitant Brugada-like and short QT electrocardiogram linked to SCN5A mutation

“…The lack of cardiac symptoms may result from the phenotypes of BrS and SQTS being only partially penetrant. These phenotypes often become more apparent in the presence of external factors, such as medication (sodium channel blocker), fever, 10 or electrolyte disorder. Because the ECG of this patient was not the typical type 1 Brugada ECG pattern, it would of course have been very interesting to see the response to a sodium channel blocker.…”

Case Report: A 40 year-old Male with Fever and Syncope

“…Overwhelmingly, the most common mutation is a loss of function mutation in the sodium channel encoded by the SCN5A gene. Traditional findings on EKG are the classic "sail" appearance of the QRS complex and ST segments in the right precordial leads which is characterized by ST segment and J-point elevation without a distinct R'-wave which downslopes into an inverted T-wave [2,3].…”

“…These findings were classically suggestive of Class I Brugada syndrome [2,3]. He was admitted to the hospital for telemetry monitoring and further evaluation of his heart condition as well as his fever.…”

“…It is believed to account for 4% of all incidences of Sudden Cardiac Death (SCD) and up to 20% of cases of SCD in which there is an absence of structural cardiac defects. Traditional findings on EKG are the classic "sail" appearance of the QRS complex and ST segments in the right pre-cordial leads, characterized by ST segment and J-point elevation without a distinct R-wave which down-slopes into an inverted T-wave [2,3]. Patients often do not experience a syncopal episode until the 4th decade of life.…”

A 14-Year Old Boy with Sore Throat and Syncope

“…Many of these cases with ECGs consistent with BS lack an accompanying syncopal episode and are often discovered unintentionally with resolution of the Brugada morphology upon treatment of fever; thereby forgoing further management other than routine follow-up. [4][5][6][7][8][9][10] There are even fewer case reports demonstrating syncope in a patient with diagnosed BS requiring invasive management. 11 In this unique case, the patient presented with syncope while febrile with pharyngitis and had an ECG indicating the possibility for BS.…”