Ventricular fibrillation arrest due to Brugada syndrome in a coronavirus disease 2019 patient with negative procainamide challenge: a case report

Zou, Guangchen; Khanna, Mukul; Zahid, Saliha; Dengle, Samir; Matta, Bhavna; Zaheer, Haris; Farrell, Matthew; Stein, Russell

doi:10.1093/ehjcr/ytab454

Cited by 1 publication

(1 citation statement)

References 13 publications

(14 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Such testing was obtained because of an unclear family history of syncope and sudden cardiac death. His son suffered a single episode of syncope presumed to be vasovagal, his father died at 75 with an extensive cardiac history, and his grandfather died suddenly in his 50s [ 15 ]. In the remaining case, no family history or previous suspicion was present.…”

Section: Discussionmentioning

confidence: 99%

Ventricular Fibrillation in an Afebrile COVID-19 Patient Presenting With Transient Type-I Brugada Pattern

Kreinbrook¹,

Foster²,

Paulino³

et al. 2023

Cureus

View full text Add to dashboard Cite

COVID-19 has been associated with an increased risk of both atrial and ventricular arrhythmias. Brugada syndrome (BrS), an inherited sodium channelopathy presenting with a characteristic ECG morphology, confers a baseline risk of ventricular arrhythmias such as ventricular fibrillation (VF), especially during febrile illnesses. However, mimics of BrS, termed Brugada phenocopies (BrP), have been noted in association with fever, electrolyte abnormalities, and toxidromes outside of viral illness. Such presentations manifest the same ECG pattern, the type-I Brugada pattern (type-I BP). Thus, the acute stage of an illness such as COVID-19, when accompanied by a first-time presentation of type-I BP, may not result in a certain diagnosis of BrS versus BrP. Thus, expert recommendations are to anticipate arrhythmia regardless of the presumed diagnosis. Here we demonstrate the importance of these guidelines and a novel report of VF in the setting of a transient type-I BP in afebrile COVID-19. We discuss the potential factors which may have triggered VF, the presentation of isolated "coved" ST elevation in V1, and the difficulty of BrS versus BrP diagnosis in acute illness. In summary, a SARS-CoV-2 positive 65-year-old male without significant cardiac history for BrS presented with type-I BP after two days of shortness of breath. Hypoxemia, hyperkalemia, hyperglycemia, elevated inflammatory markers, and acute kidney injury were present. After treatment, his ECG normalized; however, aborted VF occurred days later while afebrile and normokalemic. Follow-up ECG again revealed a type-I BP, which also became more apparent during an episode of bradycardia, a classic finding in BrS. This case suggests that there is room for larger studies to determine the prevalence and outcomes when type-I BP presents in acute COVID-19. When possible, genetic data should be obtained to confirm BrS, a notable limitation in our case. Regardless, it corroborates guideline-directed clinical management, with heightened vigilance for arrhythmia in such patients until full recovery.

show abstract

Section: Discussionmentioning

confidence: 99%