Incessant monomorphic ventricular tachycardia during febrile illness in a patient with Brugada syndrome: fatal electrical storm

Abstract

A 55-year-old male with structurally normal heart presented with sustained monomorphic ventricular tachycardia (VT) and was cardioverted into sinus rhythm revealing a right bundle branch block pattern at baseline electrocardiography. Sustained monomorphic and nonsustained polymorphic VT were reproducibly inducible during electrophysiological study. During the diagnostic workup, the patient experienced fever due to hospital based pneumonia, which unmasked typical ST segment changes of Brugada syndrome. In the intensive care unit, fever became intractable leading to incessant monomorphic VT, which was resistant to all medical manoeuvers resulting in the patient's death.

Temperature modulation of ventricular arrhythmogenicity in a canine tissue model of Brugada syndrome

“…30,34,35 However, in contrast to the enhanced J-ST elevation by fever, sympathetic nerve stimulation (by exercise or isoproterenol), although it caused sinus tachycardia, attenuated J-ST elevation in Brugada patients. 36 Thus, probably only the direct effects of temperature elevation on APD and on Na ϩ channels, and not the secondary effects mediated by autonomic regulation, can account for the enhanced J-ST elevation in association with tachycardia in Brugada patients during fever.…”

Brugada Syndrome Combined with Monomorphic Ventricular Tachycardia and Atrioventricular Nodal Reentrant Tachycardia

“…Although infrequent, there are case reports of BrS combined with sustained monomorphic VT (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Sustained monomorphic VT may be induced by exercise (8,11,14,15,17), by antiarrhythmic drugs alone (6,16) or by antiarrhythmic drugs with electrical stimulation (4,10,16).…”

A Case of Brugada Syndrome Presenting With Incessant Polymorphic Ventricular Tachycardia

“…These include sodium channel blockers, febrile state, vagotonic agents, α-adrenergic agonists, β-adrenergic blocker, antidepressants, glucose and insulin, hyperkalemia, hypokalemia, hypercalcemia, and alcohol and cocaine toxicity. 2,9 Since type 2 and type 3 Brugada patterns are nondiagnostic, sodium channel blockers including ajmaline, flecainide, procainamide, and pilsicainide can be used to unmask a type 1 pattern (Figure 2).…”