Electrocardiogram Characteristics and Arrhythmic Events during Fever in Patients with Fever-Induced Brugada Syndrome

Introduction: Changes in electrocardiogram (ECG) parameters and the incidence of arrhythmic events in patients with fever-induced Brugada syndrome (BrS) remain unknown.

Objective: We aimed to investigate the effect of hyperthermia on the ECG pattern and the occurrence of fever-triggered arrhythmic events (FTAEs) in patients with fever-induced BrS.

Methods: We retrospectively analyzed a series of fever-induced BrS cases from January 1966 to November 2018. Clinical characteristics and ECG parameters were evaluated in the presence or absence of fever.

Results: Syncope and implantable cardioverter defibrillator implantation occurred more frequently in BrS patients with FTAEs than in patients without FTAEs. In BrS patients <16 years old, more arrhythmia events occurred in patients with FTAEs than in patients without FTAEs (p = 0.04). During follow-up, 2 patients in the FTAEs group suffered new malignant arrhythmic events. Compared to the afebrile state, the J point increased significantly in precordial leads V1, V2, and V3 during the febrile state (all p < 0.01). The corrected QTpeak intervals in V1 and V2 were significantly longer in the FTAEs group than in the non-FTAEs group (354.5 ± 37.0 vs. 334.3 ± 45.5 ms, p < 0.01 and 368.0 ± 43.4 vs. 330.9 ± 41.5 ms, p < 0.01, respectively). An increased corrected QT dispersion and a lengthened corrected Tpeak-Tend dispersion were also observed during fever.

Conclusions: Fever may not only reveal BrS but also induce life-threatening arrhythmic events, especially in children and adolescents.