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Shah R. Fever induced ST-elevation in precordial leads: not to be confused with STEMI. Intern Emerg Med 2024:10.1007/s11739-024-03720-6. [PMID: 39102152 DOI: 10.1007/s11739-024-03720-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 07/18/2024] [Indexed: 08/06/2024]
Affiliation(s)
- Rahman Shah
- Department of Cardiovascular Medicine, Methodist University Hospital, 1030 Jefferson Avenue, Memphis, TN, 38104, USA.
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2
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Huttelmaier MT, Fischer TH. [Cardiac channelopathies in the context of hereditary arrhythmia syndromes]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:787-797. [PMID: 38977442 PMCID: PMC11269359 DOI: 10.1007/s00108-024-01751-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/10/2024]
Abstract
Genetic arrhythmia disorders are rare diseases; however, they are a common cause of sudden cardiac death in children, adolescents, and young adults. In principle, a distinction can be made between channelopathies and cardiomyopathies in the context of genetic diseases. This paper focuses on the channelopathies long and short QT syndrome, Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia (CPVT). Early diagnosis of these diseases is essential, as drug therapy, behavioral measures, and if necessary, implantation of a cardioverter defibrillator can significantly improve the prognosis and quality of life of patients. This paper highlights the pathophysiological and genetic basis of these channelopathies, describes their clinical manifestations, and comments on the principles of diagnosis, risk stratification and therapy.
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MESH Headings
- Humans
- Arrhythmias, Cardiac/genetics
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Arrhythmias, Cardiac/physiopathology
- Channelopathies/genetics
- Channelopathies/diagnosis
- Channelopathies/therapy
- Brugada Syndrome/genetics
- Brugada Syndrome/diagnosis
- Brugada Syndrome/physiopathology
- Brugada Syndrome/therapy
- Tachycardia, Ventricular/genetics
- Tachycardia, Ventricular/therapy
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/physiopathology
- Adolescent
- Child
- Long QT Syndrome/genetics
- Long QT Syndrome/diagnosis
- Long QT Syndrome/therapy
- Long QT Syndrome/physiopathology
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/etiology
- Adult
- Defibrillators, Implantable
- Electrocardiography
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Affiliation(s)
- Moritz T Huttelmaier
- Medizinische Klinik 1, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Thomas H Fischer
- Medizinische Klinik 1, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
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3
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Kume E, Yamakawa M, Miyakoshi C, Aota C, Tsuruta S, Horie M, Ohno S. Molecular Autopsy With Banked Cord Blood Reveals Brugada Syndrome in Past Sudden Death Case. Pediatrics 2024; 153:e2023063054. [PMID: 38721668 DOI: 10.1542/peds.2023-063054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 07/11/2024] Open
Abstract
Molecular autopsy has recently been gaining attention as a means of postmortem diagnosis; however, it is usually performed using the victim's blood sample at the time of death. Here, we report the first case of a deceased infant with Brugada syndrome whose diagnosis was made with banked cord blood. A seemingly healthy 1-year-old male infant collapsed while having a fever; this collapse was witnessed by his mother. Despite cardiopulmonary resuscitation, he died of ventricular fibrillation. No abnormalities of cardiac structure were identified on autopsy. Genomic samples were not stored at the time because of a lack of suspicion for familial arrhythmia. Five years later, his sister showed Brugada electrocardiogram pattern while febrile from Kawasaki disease. Their father showed a spontaneous type 1 Brugada electrocardiogram pattern. A heterozygous SCN5A p.R893C variant was found by genetic testing in the proband's father and sister. Furthermore, the proband's genetic testing was performed using his banked cord blood, which identified the same variant. Family history of Brugada syndrome with an SCN5A-R893C variant and clinical evidence led to a postmortem diagnosis of Brugada syndrome in the proband. Identification of this variant in this case later contributed to verifying SCN5A-R893C as a pathogenic variant through data accumulation. Banked cord blood may prove useful for conducting molecular autopsies in previously undiagnosed cases of sudden death in which genomic samples were not stored.
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Affiliation(s)
- Eitaro Kume
- Department of Pediatrics, Kyoto University Hospital, Kyoto, Japan
| | - Masaru Yamakawa
- Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Japan
- Department of Health and Well-being, Sonoda Women's University, Amagasaki, Japan
| | - Chisato Miyakoshi
- Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Chie Aota
- Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Satoru Tsuruta
- Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Minoru Horie
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Seiko Ohno
- Department of Bioscience and Genetics, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
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4
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Scrocco C, Ben-Haim Y, Ensam B, Aldous R, Tome-Esteban M, Specterman M, Papadakis M, Sharma S, Behr ER. The role for ambulatory electrocardiogram monitoring in the diagnosis and prognostication of Brugada syndrome: a sub-study of the Rare Arrhythmia Syndrome Evaluation (RASE) Brugada study. Europace 2024; 26:euae091. [PMID: 38584469 DOI: 10.1093/europace/euae091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/10/2024] [Indexed: 04/09/2024] Open
Abstract
AIMS Brugada syndrome (BrS) diagnosis and risk stratification rely on the presence of a spontaneous type 1 (spT1) electrocardiogram (ECG) pattern; however, its spontaneous fluctuations may lead to misdiagnosis and risk underestimation. This study aims to assess the role for repeat high precordial lead (HPL) resting and ambulatory ECG monitoring in identifying a spT1, and evaluate its prognostic role. METHODS AND RESULTS HPL resting and ambulatory monitoring ECGs of BrS subjects were reviewed retrospectively, and the presence of a spT1 associated with ventricular dysrhythmias and sudden cardiac death (SCD). Three-hundred and fifty-eight subjects (77 with spT1 pattern at presentation, Group 1, and 281 without, Group 2) were included. In total, 1651 resting HPL resting and 621 ambulatory monitoring ECGs were available for review, or adequately described. Over a median follow-up of 72 months (interquartile range - IQR - 75), 42/77 (55%) subjects in Group 1 showed a spT1 in at least one ECG. In Group 2, 36/281 subjects (13%) had a newly detected spT1 (1.9 per 100 person-year) and 23 on an HPL ambulatory recording (8%). Seven previously asymptomatic subjects, five of whom had a spT1 (four at presentation and one at follow-up), experienced arrhythmic events; survival analysis indicated that a spT1, either at presentation or during lifetime, was associated with events. Univariate models showed that a spT1 was consistently associated with increased risk [spT1 at presentation: hazard ratio (HR) 6.3, 95% confidence interval (CI) 1.4-28, P = 0.016; spT1 at follow-up: HR 3.1, 95% CI 1.3-7.2, P = 0.008]. CONCLUSION Repeated ECG evaluation and HPL ambulatory monitoring are vital in identifying transient spT1 Brugada pattern and its associated risk.
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Affiliation(s)
- Chiara Scrocco
- Cardiovascular Clinical Academic Group St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Yael Ben-Haim
- Cardiovascular Clinical Academic Group St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Bode Ensam
- Cardiovascular Clinical Academic Group St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Robert Aldous
- Cardiovascular Clinical Academic Group St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Maite Tome-Esteban
- Cardiovascular Clinical Academic Group St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Mark Specterman
- Cardiovascular Clinical Academic Group St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Sanjay Sharma
- Cardiovascular Clinical Academic Group St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
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5
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Zhang Z, Brugada P, Weiss JN, Qu Z. Phase 2 Re-Entry Without I to: Role of Sodium Channel Kinetics in Brugada Syndrome Arrhythmias. JACC Clin Electrophysiol 2023; 9:2459-2474. [PMID: 37831035 PMCID: PMC11348283 DOI: 10.1016/j.jacep.2023.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/27/2023] [Accepted: 08/23/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND In Brugada syndrome (BrS), phase 2 re-excitation/re-entry (P2R) induced by the transient outward potassium current (Ito) is a proposed arrhythmia mechanism; yet, the most common genetic defects are loss-of-function sodium channel mutations. OBJECTIVES The authors used computer simulations to investigate how sodium channel dysfunction affects P2R-mediated arrhythmogenesis in the presence and absence of Ito. METHODS Computer simulations were carried out in 1-dimensional cables and 2-dimensional tissue using guinea pig and human ventricular action potential models. RESULTS In the presence of Ito sufficient to generate robust P2R, reducing sodium current (INa) peak amplitude alone only slightly potentiated P2R. When INa inactivation kinetics were also altered to simulate reported effects of BrS mutations and sodium channel blockers, however, P2R occurred even in the absence of Ito. These effects could be potentiated by delaying L-type calcium channel activation or increasing ATP-sensitive potassium current, consistent with experimental and clinical findings. INa-mediated P2R also accounted for sex-related, day and night-related, and fever-related differences in arrhythmia risk in BrS patients. CONCLUSIONS Altered INa kinetics synergize powerfully with reduced INa amplitude to promote P2R-induced arrhythmias in BrS in the absence of Ito, establishing a robust mechanistic link between altered INa kinetics and the P2R-mediated arrhythmia mechanism.
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Affiliation(s)
- Zhaoyang Zhang
- Department of Physics, School of Physical Science and Technology, Ningbo University, Ningbo, Zhejiang, China; Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - James N Weiss
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Zhilin Qu
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
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6
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Theisen B, Holtz A, Rajagopalan V. Noncoding RNAs and Human Induced Pluripotent Stem Cell-Derived Cardiomyocytes in Cardiac Arrhythmic Brugada Syndrome. Cells 2023; 12:2398. [PMID: 37830612 PMCID: PMC10571919 DOI: 10.3390/cells12192398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
Hundreds of thousands of people die each year as a result of sudden cardiac death, and many are due to heart rhythm disorders. One of the major causes of these arrhythmic events is Brugada syndrome, a cardiac channelopathy that results in abnormal cardiac conduction, severe life-threatening arrhythmias, and, on many occasions, death. This disorder has been associated with mutations and dysfunction of about two dozen genes; however, the majority of the patients do not have a definite cause for the diagnosis of Brugada Syndrome. The protein-coding genes represent only a very small fraction of the mammalian genome, and the majority of the noncoding regions of the genome are actively transcribed. Studies have shown that most of the loci associated with electrophysiological traits are located in noncoding regulatory regions and are expected to affect gene expression dosage and cardiac ion channel function. Noncoding RNAs serve an expanding number of regulatory and other functional roles within the cells, including but not limited to transcriptional, post-transcriptional, and epigenetic regulation. The major noncoding RNAs found in Brugada Syndrome include microRNAs; however, others such as long noncoding RNAs are also identified. They contribute to pathogenesis by interacting with ion channels and/or are detectable as clinical biomarkers. Stem cells have received significant attention in the recent past, and can be differentiated into many different cell types including those in the heart. In addition to contractile and relaxational properties, BrS-relevant electrophysiological phenotypes are also demonstrated in cardiomyocytes differentiated from stem cells induced from adult human cells. In this review, we discuss the current understanding of noncoding regions of the genome and their RNA biology in Brugada Syndrome. We also delve into the role of stem cells, especially human induced pluripotent stem cell-derived cardiac differentiated cells, in the investigation of Brugada syndrome in preclinical and clinical studies.
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Affiliation(s)
- Benjamin Theisen
- Department of Biomedical and Anatomical Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR 72401, USA
| | - Austin Holtz
- Department of Biomedical and Anatomical Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR 72401, USA
| | - Viswanathan Rajagopalan
- Department of Biomedical and Anatomical Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR 72401, USA
- Arkansas Biosciences Institute, Jonesboro, AR 72401, USA
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7
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Ishibashi Y, Zhang S, Tamura S, Ishii H. Brugada phenocopy with altered ST-segment elevation in pericardial diffuse large B-cell lymphoma and effusive-constrictive pericarditis: a case report. Eur Heart J Case Rep 2023; 7:ytad463. [PMID: 37854103 PMCID: PMC10580269 DOI: 10.1093/ehjcr/ytad463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/26/2023] [Accepted: 09/11/2023] [Indexed: 10/20/2023]
Abstract
Background Cardiac lymphoma is a rare disease. Effusive-constrictive pericarditis can be a characteristic of pericardial involvement in patients with this disease. Conversely, a phenotype with electrocardiogram changes similar to those of Brugada syndrome is called Brugada phenocopy, and these changes improve after treatment. Case summary A 71-year-old man was transported to our hospital with chest pain, hypotension, and ST-segment elevation in V1 and V2 leads during maintenance dialysis for renal failure. After arrival at the hospital, his ST-segment elevation disappeared, and emergency coronary angiography scan revealed no significant coronary artery stenoses or obstructions. His computed tomography and echocardiography scans revealed pericardial effusion and an intrapericardial mass. Further, his blood pressure dropped and ST-segment elevation recurred during dialysis after 7 days. Thus, pericardiocentesis was performed, but haemodynamic improvement was insufficient, and right catheterization findings suggested effusive-constrictive pericarditis. Meanwhile, flow cytometry of the pericardial fluid suggested the diagnosis of B-cell lymphoma; however, radical chemoradiotherapy was impossible because of cardiogenic shock. The patient died on Day 17. Further, autopsy revealed diffuse large B-cell lymphoma with pericardial and myocardial infiltration. Discussion Cardiac lymphoma is rare but can be associated with effusive-constrictive pericarditis, which may be difficult to manage even with pericardial drainage. In such cases, radical treatment, including chemotherapy, should be promptly considered, if possible. Our patient presented with Brugada-type electrocardiogram but no syncope or family history, suggesting Brugada phenocopy and not true Brugada syndrome due to cardiac lymphoma. Notably, temporary improvement in ST-segment elevation was observed despite the absence of treatment.
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Affiliation(s)
- Yohei Ishibashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-15, Showa Maebashi, Gunma 371-8511, Japan
- Department of Cardiology, National Hospital Organization Takasaki General Medical Center, 36, Takamatsu Takasaki, Gunma 370-0829, Japan
| | - Shanshan Zhang
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-15, Showa Maebashi, Gunma 371-8511, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-15, Showa Maebashi, Gunma 371-8511, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-15, Showa Maebashi, Gunma 371-8511, Japan
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8
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Ma JF, Zhou Y, Fu HX. Ventricular fibrillation induced by fever in structurally normal hearts. Front Cardiovasc Med 2023; 10:1230295. [PMID: 37817866 PMCID: PMC10561293 DOI: 10.3389/fcvm.2023.1230295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/25/2023] [Indexed: 10/12/2023] Open
Abstract
Ventricular fibrillation (VF) is a life-threatening arrhythmia that usually happens in patients with structural heart diseases. However, fever-induced ventricular fibrillation in structurally normal hearts was reported, and the four main diseases associated with these cases were Brugada syndrome, long QT syndrome, idiopathic ventricular fibrillation, and non-cardiovascular diseases. In this review, we analyzed this phenomenon and its clinical characteristics.
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Affiliation(s)
- Ji-Fang Ma
- Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
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9
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Pari B, Babbili A, Kattubadi A, Thakre A, Thotamgari S, Gopinathannair R, Olshansky B, Dominic P. COVID-19 Vaccination and Cardiac Arrhythmias: A Review. Curr Cardiol Rep 2023; 25:925-940. [PMID: 37530946 DOI: 10.1007/s11886-023-01921-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE OF REVIEW In this review, we aim to delve into the existing literature, seeking to uncover the mechanisms, investigate the electrocardiographic changes, and examine the treatment methods of various cardiac arrhythmias that occur after administration of the COVID-19 vaccine. RECENT FINDINGS A global survey has exposed an incidence of arrhythmia in 18.27% of hospitalized COVID-19 patients. Furthermore, any type of COVID-19 vaccine - be it mRNA, adenovirus vector, whole inactivated, or protein subunit - appears to instigate cardiac arrhythmias. Among the cardiac adverse events reported post-COVID-19 vaccination, myocarditis emerges as the most common and is thought to be a potential cause of bradyarrhythmia. When a patient post-COVID-19 vaccination presents a suspicion of cardiac involvement, clinicians should perform a comprehensive history and physical examination, measure electrolyte levels, conduct ECG, and carry out necessary imaging studies. In our extensive literature search, we uncovered various potential mechanisms that might lead to cardiac conduction abnormalities and autonomic dysfunction in patients who have received the COVID-19 vaccine. These mechanisms encompass direct viral invasion through molecular mimicry/spike (S) protein production, an escalated inflammatory response, hypoxia, myocardial cell death, and the eventual scar/fibrosis. They correspond to a range of conditions including atrial tachyarrhythmias, bradyarrhythmia, ventricular arrhythmias, sudden cardiac death, and the frequently occurring myocarditis. For treating these COVID-19 vaccination-induced arrhythmias, we should incorporate general treatment strategies, similar to those applied to arrhythmias from other causes.
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Affiliation(s)
- Bavithra Pari
- Department of Medicine, LSUHSC-S, Shreveport, LA, USA
| | | | | | - Anuj Thakre
- Department of Medicine, LSUHSC-S, Shreveport, LA, USA
| | | | - Rakesh Gopinathannair
- The Kansas City Heart Rhythm Institute (KCHRI) & Research Foundation, Overland Park Regional Medical Center, KS, Kansas City, USA
| | - Brian Olshansky
- Division of Cardiology, Department of Medicine, The University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | - Paari Dominic
- Division of Cardiology, Department of Medicine, The University of Iowa, Carver College of Medicine, Iowa City, IA, USA.
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10
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Brohus M, Busuioc AO, Wimmer R, Nyegaard M, Overgaard MT. Calmodulin mutations affecting Gly114 impair binding to the Na V1.5 IQ-domain. Front Pharmacol 2023; 14:1210140. [PMID: 37663247 PMCID: PMC10469309 DOI: 10.3389/fphar.2023.1210140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/25/2023] [Indexed: 09/05/2023] Open
Abstract
Missense variants in CALM genes encoding the Ca2+-binding protein calmodulin (CaM) cause severe cardiac arrhythmias. The disease mechanisms have been attributed to dysregulation of RyR2, for Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) and/or CaV1.2, for Long-QT Syndrome (LQTS). Recently, a novel CALM2 variant, G114R, was identified in a mother and two of her four children, all of whom died suddenly while asleep at a young age. The G114R variant impairs closure of CaV1.2 and RyR2, consistent with a CPVT and/or mild LQTS phenotype. However, the children carrying the CALM2 G114R variant displayed a phenotype commonly observed with variants in NaV1.5, i.e., Brugada Syndrome (BrS) or LQT3, where death while asleep is a common feature. We therefore hypothesized that the G114R variant specifically would interfere with NaV1.5 binding. Here, we demonstrate that CaM binding to the NaV1.5 IQ-domain is severely impaired for two CaM variants G114R and G114W. The impact was most severe at low and intermediate Ca2+ concentrations (up to 4 µM) resulting in more than a 50-fold reduction in NaV1.5 binding affinity, and a smaller 1.5 to 11-fold reduction at high Ca2+ concentrations (25-400 µM). In contrast, the arrhythmogenic CaM-N98S variant only induced a 1.5-fold reduction in NaV1.5 binding and only at 4 µM Ca2+. A non-arrhythmogenic I10T variant in CaM did not impair NaV1.5 IQ binding. These data suggest that the interaction between NaV1.5 and CaM is decreased with certain CaM variants, which may alter the cardiac sodium current, INa. Overall, these results suggest that the phenotypic spectrum of calmodulinopathies may likely expand to include BrS- and/or LQT3-like traits.
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Affiliation(s)
- Malene Brohus
- Department of Chemistry and Bioscience, Aalborg University, Aalborg, Denmark
| | - Ana-Octavia Busuioc
- Department of Chemistry and Bioscience, Aalborg University, Aalborg, Denmark
| | - Reinhard Wimmer
- Department of Chemistry and Bioscience, Aalborg University, Aalborg, Denmark
| | - Mette Nyegaard
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
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Altermanini M, Habib MB, Alkhiyami D, Ali K, Abdelghani MS, Hamamyh T, Elyas A, Elhassan M. Syncope following Pfizer BioNTech (bnt162b2) vaccination unmasking Brugada syndrome. Heliyon 2023; 9:e18716. [PMID: 37576199 PMCID: PMC10415666 DOI: 10.1016/j.heliyon.2023.e18716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 07/10/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023] Open
Abstract
The Brugada syndrome is an uncommon inherited condition associated with increased risk of ventricular tachyarrhythmias and sudden cardiac death. Different triggers including fever are well known to precipitate the Brugada pattern on electrocardiogram. We report a patient who presents with syncope, two days after the first dose of the BNT162b2 vaccine due to fever-related unmasking of Brugada syndrome.
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Affiliation(s)
| | - Mhd Baraa Habib
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Khaled Ali
- Community Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Tahseen Hamamyh
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Elyas
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mawahib Elhassan
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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12
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Meier S, Grundland A, Dobrev D, Volders PG, Heijman J. In silico analysis of the dynamic regulation of cardiac electrophysiology by K v 11.1 ion-channel trafficking. J Physiol 2023; 601:2711-2731. [PMID: 36752166 PMCID: PMC10313819 DOI: 10.1113/jp283976] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
Cardiac electrophysiology is regulated by continuous trafficking and internalization of ion channels occurring over minutes to hours. Kv 11.1 (also known as hERG) underlies the rapidly activating delayed-rectifier K+ current (IKr ), which plays a major role in cardiac ventricular repolarization. Experimental characterization of the distinct temporal effects of genetic and acquired modulators on channel trafficking and gating is challenging. Computer models are instrumental in elucidating these effects, but no currently available model incorporates ion-channel trafficking. Here, we present a novel computational model that reproduces the experimentally observed production, forward trafficking, internalization, recycling and degradation of Kv 11.1 channels, as well as their modulation by temperature, pentamidine, dofetilide and extracellular K+ . The acute effects of these modulators on channel gating were also incorporated and integrated with the trafficking model in the O'Hara-Rudy human ventricular cardiomyocyte model. Supraphysiological dofetilide concentrations substantially increased Kv 11.1 membrane levels while also producing a significant channel block. However, clinically relevant concentrations did not affect trafficking. Similarly, severe hypokalaemia reduced Kv 11.1 membrane levels based on long-term culture data, but had limited effect based on short-term data. By contrast, clinically relevant elevations in temperature acutely increased IKr due to faster kinetics, while after 24 h, IKr was decreased due to reduced Kv 11.1 membrane levels. The opposite was true for lower temperatures. Taken together, our model reveals a complex temporal regulation of cardiac electrophysiology by temperature, hypokalaemia, and dofetilide through competing effects on channel gating and trafficking, and provides a framework for future studies assessing the role of impaired trafficking in cardiac arrhythmias. KEY POINTS: Kv 11.1 channels underlying the rapidly activating delayed-rectifier K+ current are important for ventricular repolarization and are continuously shuttled from the cytoplasm to the plasma membrane and back over minutes to hours. Kv 11.1 gating and trafficking are modulated by temperature, drugs and extracellular K+ concentration but experimental characterization of their combined effects is challenging. Computer models may facilitate these analyses, but no currently available model incorporates ion-channel trafficking. We introduce a new two-state ion-channel trafficking model able to reproduce a wide range of experimental data, along with the effects of modulators of Kv 11.1 channel functioning and trafficking. The model reveals complex dynamic regulation of ventricular repolarization by temperature, extracellular K+ concentration and dofetilide through opposing acute (millisecond) effects on Kv 11.1 gating and long-term (hours) modulation of Kv 11.1 trafficking. This in silico trafficking framework provides a tool to investigate the roles of acute and long-term processes on arrhythmia promotion and maintenance.
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Affiliation(s)
- Stefan Meier
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Faculty of Health, Medicine, and Life Sciences, Maastricht University and Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Adaïa Grundland
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Faculty of Health, Medicine, and Life Sciences, Maastricht University and Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Data Science and Knowledge Engineering, Faculty of Science and Engineering, Maastricht University, Maastricht, The Netherlands
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
- Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Quebec, Canada
| | - Paul G.A. Volders
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Faculty of Health, Medicine, and Life Sciences, Maastricht University and Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jordi Heijman
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Faculty of Health, Medicine, and Life Sciences, Maastricht University and Maastricht University Medical Center+, Maastricht, The Netherlands
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13
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Elkattawy S, Romero J, Romero AL, Elkattawy O, Sodhi S, Shamoon F. A Classic Pattern of Type 1 Brugada Syndrome on ECG: A Case Report. J Community Hosp Intern Med Perspect 2023; 13:88-90. [PMID: 37868234 PMCID: PMC10589026 DOI: 10.55729/2000-9666.1187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 10/24/2023] Open
Abstract
Brugada syndrome is an inherited disorder characterized by a channelopathy of cardiac sodium, potassium, and calcium channel. The pathophysiology of this disorder is not completely elucidated yet, however, most of the reported cases are caused by a pathogenic alteration in the SCN5A gene, leading to the malfunction of cardiac sodium channels. Several stressors are well known to unmask this pathology including fever and electrolytes imbalance. Three ECG patterns are frequently described in the literature, type 1, type 2, and type 3. However, only the type 1 pattern is considered diagnostic of Brugada syndrome in the appropriate clinical context. Therapeutic strategies can range from conservative medical management with antiarrhythmic medications to Automatic Implantable Cardioverter Defibrillator (AICD) placement. Prompt recognition is of utmost importance since this pathology can rapidly evolve into life-threatening arrhythmias and sudden cardiac death. Here we present a case of a 22-year-old male who presented after a syncopal episode and was found to have Brugada syndrome in the setting of Influenza A infection.
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Affiliation(s)
- Sherif Elkattawy
- Cardiology Department, St. Joseph’s University Medical Center, Paterson, NJ,
USA
| | - Jesus Romero
- Internal Medicine Department, RWJBarnabas Health/Trinitas Regional Medical Center, Elizabeth, NJ,
USA
| | - Ana L. Romero
- Internal Medicine Department, RWJBarnabas Health/Trinitas Regional Medical Center, Elizabeth, NJ,
USA
| | - Omar Elkattawy
- Internal Medicine Department, Rutgers University-New Brunswick, Jersey City, NJ,
USA
| | - Sohail Sodhi
- Internal Medicine Department, RWJBarnabas Health/Trinitas Regional Medical Center, Elizabeth, NJ,
USA
| | - Fayez Shamoon
- Cardiology Department, St. Joseph’s University Medical Center, Paterson, NJ,
USA
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14
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Hsu CH, Lin SH, Chang LY. Anesthesia in patients with Brugada syndrome: two case reports. J Med Case Rep 2023; 17:275. [PMID: 37322558 DOI: 10.1186/s13256-023-03934-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/17/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Brugada syndrome is a rare disease. It causes sudden cardiac arrest, which is a serious life-threatening event. Sudden cardiac death mostly results from coronary artery disease. However, patients with Brugada syndrome show normal cardiac anatomy and no evidence of ischemia or electrolyte imbalance. Anesthesia in patients with Brugada syndrome is challenging due to its unpredictable nature, and is worth our attention. CASE PRESENTATION We report two cases of Brugada syndrome during anesthesia. In case one, a 31-year-old Filipino laborer was scheduled for laparoscopic appendectomy. The patient denied any preexisting cardiac disease. The preoperative vital signs were stable, with mild fever of 37.9 °C. The operation was smooth. During the emergence period, the patient suffered from sudden onset of ventricular tachycardia. After resuscitation, the cardiac rhythm returned to normal. Later, he was confirmed to have a genetic trait of Brugada syndrome. In case two, a young Taiwanese patient with pre-diagnosed Brugada syndrome underwent an operation. The perioperative precautions were taken to prevent the occurrence of ventricular arrhythmia. The surgery was uneventful. CONCLUSIONS Brugada syndrome, although rare, has the highest incidence in South East Asian healthy young males. It brings attention to possible fatal cardiac arrhythmia in this population. Careful preoperative evaluation and perioperative management can help reduce the harmful outcome of the disease and prevent any untoward events.
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Affiliation(s)
- Che-Hao Hsu
- Department of Anesthesiology, Tungs' Taichung MetroHarbor Hospital, Taichung, 43503, Taiwan.
| | - Shin-Hong Lin
- Department of Anesthesiology, Tungs' Taichung MetroHarbor Hospital, Taichung, 43503, Taiwan
| | - Li-Yen Chang
- Department of Anesthesiology, Tungs' Taichung MetroHarbor Hospital, Taichung, 43503, Taiwan
- Department of Anesthesiology, Taichung Armed Forces General Hospital, Taichung, 41169, Taiwan
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15
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Casella M, Conti S, Compagnucci P, Ribatti V, Narducci ML, Marcon L, Massara F, Valeri Y, De Francesco L, Martino AM, Ghiglieno C, Schiavone M, Balla C, Dell'Era G, Pelargonio G, Forleo GB, Iacopino S, Sgarito G, Calò L, Tondo C, Russo AD, Patti G. Incidence of ventricular arrhythmias related to COVID infection and vaccination in patients with Brugada syndrome: Insights from a large Italian multicenter registry based on continuous rhythm monitoring. J Cardiovasc Electrophysiol 2023; 34:1386-1394. [PMID: 37194742 DOI: 10.1111/jce.15929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/04/2023] [Accepted: 05/03/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Brugada syndrome (BrS) has a dynamic ECG pattern that might be revealed by certain conditions such as fever. We evaluated the incidence and management of ventricular arrhythmias (VAs) related to COVID-19 infection and vaccination among BrS patients carriers of an implantable loop recorder (ILR) or implantable cardioverter-defibrillator (ICD) and followed by remote monitoring. METHODS This was a multicenter retrospective study. Patients were carriers of devices with remote monitoring follow-up. We recorded VAs 6 months before COVID-19 infection or vaccination, during infection, at each vaccination, and up to 6-month post-COVID-19 or 1 month after the last vaccination. In ICD carriers, we documented any device intervention. RESULTS We included 326 patients, 202 with an ICD and 124 with an ILR. One hundred and nine patients (33.4%) had COVID-19, 55% of whom developed fever. Hospitalization rate due to COVID-19 infection was 2.76%. After infection, we recorded only two ventricular tachycardias (VTs). After the first, second, and third vaccines, the incidence of non-sustained ventricular tachycardia (NSVT) was 1.5%, 2%, and 1%, respectively. The incidence of VT was 1% after the second dose. Six-month post-COVID-19 healing or 1 month after the last vaccine, we documented NSVT in 3.4%, VT in 0.5%, and ventricular fibrillation in 0.5% of patients. Overall, one patient received anti-tachycardia pacing and one a shock. ILR carriers had no VAs. No differences were found in VT before and after infection and before and after each vaccination. CONCLUSIONS From this large multicenter study conducted in BrS patients, followed by remote monitoring, the overall incidence of sustained VAs after COVID-19 infection and vaccination is relatively low.
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Affiliation(s)
- Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Sergio Conti
- Department of Electrophysiology, ARNAS Civico - Di Cristina - Benfratelli, Palermo, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
- Department of Biomedical Science and Public Health, Marche Polytechnic University, Ancona, Italy
| | | | | | | | - Francesca Massara
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Yari Valeri
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Luca De Francesco
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Chiara Ghiglieno
- Division of Cardiology, University Hospital Maggiore della Carità, University of Eastern Piedmont, Novara, Italy
| | | | - Cristina Balla
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy
| | - Gabriele Dell'Era
- Division of Cardiology, University Hospital Maggiore della Carità, University of Eastern Piedmont, Novara, Italy
| | - Gemma Pelargonio
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | | | - Giuseppe Sgarito
- Department of Electrophysiology, ARNAS Civico - Di Cristina - Benfratelli, Palermo, Italy
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Rome, Italy
| | - Claudio Tondo
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgery and Dental Sciences, University of Milan, Milan, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
- Department of Biomedical Science and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Giuseppe Patti
- Division of Cardiology, University Hospital Maggiore della Carità, University of Eastern Piedmont, Novara, Italy
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16
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Bijak P, Traykov VB, Sabbag A, Conti S, Sohns C, Matusik PT. Fever-Induced Brugada Sign: Clue for Clinical Management with Non-Negligible Risk of Sudden Cardiac Death. J Clin Med 2023; 12:jcm12103503. [PMID: 37240608 DOI: 10.3390/jcm12103503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Brugada syndrome (BrS) is a primary electrical disease predisposing to ventricular tachyarrhythmias and sudden cardiac death [...].
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Affiliation(s)
- Piotr Bijak
- Cardiology Outpatient Clinic, The John Paul II Hospital, 31-202 Kraków, Poland
| | - Vassil B Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, 1407 Sofia, Bulgaria
| | - Avi Sabbag
- The Davidai Center for Rhythm Disturbances and Pacing, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel
| | - Sergio Conti
- Department of Cardiology, Electrophysiology Department, ARNAS Ospedali Civico Di Cristina Benfratelli, 90127 Palermo, Italy
| | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Paweł T Matusik
- Department of Electrocardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 31-202 Kraków, Poland
- Department of Electrocardiology, The John Paul II Hospital, 31-202 Kraków, Poland
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17
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Liu K, Chen K, Uzunoglu EC, Rathore A, Deol T, Wu E, Elayi CS, Suryanarayana PG, Keim SG, Catanzaro JN. COVID-19-associated Brugada pattern electrocardiogram: Systematic review of case reports. Ann Noninvasive Electrocardiol 2023; 28:e13051. [PMID: 36811259 PMCID: PMC10196099 DOI: 10.1111/anec.13051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 01/21/2023] [Indexed: 02/24/2023] Open
Abstract
AIMS To summarize published case reports of patients diagnosed with coronavirus disease 2019 (COVID-19) and Brugada pattern electrocardiogram (ECG). METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist were followed. A literature search was conducted using PubMed, EMBASE, and Scopus up until September 2021. The incidence, clinical characteristics, and management outcomes of COVID-19 patients with a Brugada pattern ECG were identified. RESULTS A total of 18 cases were collected. The mean age was 47.1 years and 11.1% were women. No patients had prior confirmed diagnosis of Brugada syndrome. The most common presenting clinical symptoms were fever (83.3%), chest pain (38.8%), shortness of breath (38.8%), and syncope (16.6%). All 18 patients presented with type 1 Brugada pattern ECG. Four patients (22.2%) underwent left heart catheterization, and none demonstrated the presence of obstructive coronary disease. The most common reported therapies included antipyretics (55.5%), hydroxychloroquine (27.7%), and antibiotics (16.6%). One patient (5.5%) died during hospitalization. Three patients (16.6%) who presented with syncope received either an implantable cardioverter defibrillator or wearable cardioverter defibrillator at discharge. At follow-up, 13 patients (72.2%) had resolution of type 1 Brugada pattern ECG. CONCLUSION COVID-19-associated Brugada pattern ECG seems relatively rare. Most patients had resolution of the ECG pattern once their symptoms have improved. Increased awareness and timely use of antipyretics is warranted in this population.
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Affiliation(s)
- Kevin Liu
- Department of Medicine, Division of Cardiology, Section of ElectrophysiologyUniversity of Florida Health Science CenterFloridaJacksonvilleUSA
| | - Kai Chen
- Department of Medicine, Division of Cardiology, Section of ElectrophysiologyUniversity of Florida Health Science CenterFloridaJacksonvilleUSA
| | - Ekin C. Uzunoglu
- Department of Medicine, Division of Cardiology, Section of ElectrophysiologyUniversity of Florida Health Science CenterFloridaJacksonvilleUSA
| | - Azeem Rathore
- Department of Medicine, Division of Cardiology, Section of ElectrophysiologyUniversity of Florida Health Science CenterFloridaJacksonvilleUSA
| | - Tanya Deol
- Department of Medicine, Division of Cardiology, Section of ElectrophysiologyUniversity of Florida Health Science CenterFloridaJacksonvilleUSA
| | - Ele Wu
- Department of Medicine, Division of Cardiology, Section of ElectrophysiologyUniversity of Florida Health Science CenterFloridaJacksonvilleUSA
| | | | - Prakash G. Suryanarayana
- Department of Medicine, Division of Cardiology, Section of ElectrophysiologyUniversity of Florida Health Science CenterFloridaJacksonvilleUSA
| | - Stephen G. Keim
- Department of Medicine, Division of Cardiology, Section of ElectrophysiologyUniversity of Florida Health Science CenterFloridaJacksonvilleUSA
| | - John N. Catanzaro
- Department of Medicine, Division of Cardiology, Section of ElectrophysiologyUniversity of Florida Health Science CenterFloridaJacksonvilleUSA
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18
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Ono R, Hori Y, Yamazaki T, Takahashi H, Fukushima K. Cardiac Arrest Due to Brugada Syndrome Associated With Influenza Infection: A Case Report and Literature Review. Cureus 2023; 15:e37158. [PMID: 37168174 PMCID: PMC10166275 DOI: 10.7759/cureus.37158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 05/13/2023] Open
Abstract
A 38-year-old Japanese male with no significant medical history but a family history of sudden cardiac death was referred for cardiac arrest. He had a fever (40°C) one day before his visit. His wife reported that he groaned while unconscious, which prompted a referral to the authors' hospital. He was febrile and experienced ventricular fibrillation in the emergency department. After the resolution of ventricular fibrillation, electrocardiography revealed a right bundle branch block with ST-segment elevation in leads V1-3, consistent with a Brugada electrocardiographic pattern; he also tested positive for influenza A infection. Antiarrhythmic and antipyretic agents were administered, and peramivir was initiated; a fatal arrhythmia did not occur. A cardioverter-defibrillator was implanted, and the patient was discharged without complications. Brugada syndrome is a genetic disease that causes fatal cardiac arrhythmias, with fever recognized to induce the Brugada electrocardiographic pattern. The mechanism of the Brugada-type electrocardiographic pattern, right bundle branch block, and ST-segment elevation in the right precordial leads is considered to be the result of an outward shift of ionic currents during early repolarization, causing a marked abbreviation of the action potential in epicardial cells of the right ventricle. Activation and inactivation kinetics for early sodium currents are faster at higher temperatures. To date, there have only been four published reports describing Brugada-like electrocardiographic changes associated with fever related to influenza infection, and this is the first report of cardiac arrest. Since influenza infection can cause high fever and trigger the fetal arrhythmia of Brugada syndrome, it is important to shorten the duration of the fever. Anti-influenza therapy may be considered in patients who have a history of sudden cardiac arrest in the family, as influenza may influence the development of the Brugada ECG pattern in these individuals. The authors also review the literature on Brugada-like electrocardiographic changes induced by influenza infection. Physicians should be aware that Brugada's electrocardiographic pattern and cardiac arrest can be caused by febrile episodes, including those related to influenza infection.
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Affiliation(s)
- Ryohei Ono
- Department of Cardiology, Matsudo City General Hospital, Chiba, JPN
| | - Yasuhiko Hori
- Department of Cardiology, Matsudo City General Hospital, Chiba, JPN
| | - Tatsuro Yamazaki
- Department of Cardiology, Matsudo City General Hospital, Chiba, JPN
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19
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Brugada Syndrome: When Strict Treatment of Febrile Episodes Really Matters. J Community Hosp Intern Med Perspect 2023; 12:104-107. [PMID: 36816169 PMCID: PMC9924634 DOI: 10.55729/2000-9666.1104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/16/2022] [Accepted: 06/30/2022] [Indexed: 11/12/2022] Open
Abstract
We present a case of Brugada syndrome (BrS) diagnosed in a 32-year-old male during a febrile episode. This syndrome has characteristic ECG findings and predisposes patients to ventricular tachyarrhythmias and sudden cardiac death. We would like to highlight the necessity of aggressively treating febrile episodes in patients with BrS. The degree of risk for malignant arrhythmias in asymptomatic patients diagnosed with BrS is not clear. However, the potential for malignant arrhythmia is still there and increases in the setting of febrile episodes.
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20
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Popa IP, Șerban DN, Mărănducă MA, Șerban IL, Tamba BI, Tudorancea I. Brugada Syndrome: From Molecular Mechanisms and Genetics to Risk Stratification. Int J Mol Sci 2023; 24:ijms24043328. [PMID: 36834739 PMCID: PMC9967917 DOI: 10.3390/ijms24043328] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/13/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Brugada syndrome (BrS) is a rare hereditary arrhythmia disorder, with a distinctive ECG pattern, correlated with an increased risk of ventricular arrhythmias and sudden cardiac death (SCD) in young adults. BrS is a complex entity in terms of mechanisms, genetics, diagnosis, arrhythmia risk stratification, and management. The main electrophysiological mechanism of BrS requires further research, with prevailing theories centered on aberrant repolarization, depolarization, and current-load match. Computational modelling, pre-clinical, and clinical research show that BrS molecular anomalies result in excitation wavelength (k) modifications, which eventually increase the risk of arrhythmia. Although a mutation in the SCN5A (Sodium Voltage-Gated Channel Alpha Subunit 5) gene was first reported almost two decades ago, BrS is still currently regarded as a Mendelian condition inherited in an autosomal dominant manner with incomplete penetrance, despite the recent developments in the field of genetics and the latest hypothesis of additional inheritance pathways proposing a more complex mode of inheritance. In spite of the extensive use of the next-generation sequencing (NGS) technique with high coverage, genetics remains unexplained in a number of clinically confirmed cases. Except for the SCN5A which encodes the cardiac sodium channel NaV1.5, susceptibility genes remain mostly unidentified. The predominance of cardiac transcription factor loci suggests that transcriptional regulation is essential to the Brugada syndrome's pathogenesis. It appears that BrS is a multifactorial disease, which is influenced by several loci, each of which is affected by the environment. The primary challenge in individuals with a BrS type 1 ECG is to identify those who are at risk for sudden death, researchers propose the use of a multiparametric clinical and instrumental strategy for risk stratification. The aim of this review is to summarize the latest findings addressing the genetic architecture of BrS and to provide novel perspectives into its molecular underpinnings and novel models of risk stratification.
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Affiliation(s)
- Irene Paula Popa
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Dragomir N. Șerban
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Minela Aida Mărănducă
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Ionela Lăcrămioara Șerban
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Bogdan Ionel Tamba
- Department of Pharmacology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Correspondence:
| | - Ionuț Tudorancea
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
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21
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Fir(e)ing the Rhythm. JACC Basic Transl Sci 2023. [DOI: 10.1016/j.jacbts.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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22
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Chen GX, Barajas-Martínez H, Ciconte G, Wu CI, Monasky MM, Xia H, Li B, Capra JA, Guo K, Zhang ZH, Chen X, Yang B, Jiang H, Tse G, Mak CM, Aizawa Y, Gollob MH, Antzelevitch C, Wilde AAM, Pappone C, Hu D. Clinical characteristics and electrophysiologic properties of SCN5A variants in fever-induced Brugada syndrome. EBioMedicine 2023; 87:104388. [PMID: 36516610 PMCID: PMC9768239 DOI: 10.1016/j.ebiom.2022.104388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 10/12/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Brugada syndrome (BrS) is a severe inherited arrhythmia syndrome that can be unmasked by fever. METHODS A multicentre clinical analysis was performed in 261 patients diagnosed with fever-induced BrS, including 198 (75.9%) and 27 (10.3%) patients who received next-generation genetic sequencing and epicardial arrhythmogenic substrate (AS) mapping, respectively. FINDINGS In fever-induced BrS patients, pathogenic or likely pathogenic (P/LP) SCN5A variant carriers developed fever-induced BrS at a younger age, and more often in females and those of Caucasian descent. They exhibited significant electrophysical abnormalities, including a larger epicardial AS area, and more prolonged abnormal epicardial electrograms. During a median follow-up of 50.5 months (quartiles 32.5-81.5 months) after the diagnosis, major cardiac events (MCE) occurred in 27 (14.4%) patients. Patients with P/LP SCN5A variants had a higher ratio of MCE compared with the rest. Additionally, history of syncope, QRS duration, and Tpe interval could also predict an increased risk for future MCE according to univariate analysis. Multivariate analysis indicated that only P/LP SCN5A variants were independent significant predictors of MCE. Computational structural modelling showed that most variants are destabilizing, suggesting that Nav1.5 structure destabilization caused by SCN5A missense variants may contribute to fever-induced BrS. INTERPRETATION In our cohort, P/LP SCN5A variant carriers with fever-induced BrS are more prevalent among patients of Caucasian descent, females, and younger patients. These patients exhibit aggressive electrophysiological abnormalities and worse outcome, which warrants closer monitoring and more urgent management of fever. FUNDING The current work was supported by the National Natural Science Foundation Project of China (Nos. 82270332 & 81670304), The Fundamental Research Funds for the Central Universities of China - Independent Research Project of Wuhan University (No. 2042022kf1217) from China; the National Institutes of Health of USA [NIH R56 (HL47678), NIH R01 (HL138103), and NIH R01 (HL152201)], the W. W. Smith Charitable Trust and the Wistar and Martha Morris Fund, Sharpe-Strumia Research Foundation, the American Heart Association Postdoctoral Fellowship (20POST35220002) from United States; the Netherlands CardioVascular Research Initiative: the Dutch Heart Foundation, Dutch Federation of University Medical Centers, the Netherlands Organization for Health Research and Development, and the Royal Netherlands Academy of Sciences (PREDICT2) from the Netherlands.
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Affiliation(s)
- Gan-Xiao Chen
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Hector Barajas-Martínez
- Lankenau Institute for Medical Research and Lankenau Heart Institute, Wynnwood, PA, USA; Jefferson Medical College, Philadelphia, PA, USA
| | - Giuseppe Ciconte
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy; Vita-Salute San Raffaele University, Milan, Italy; Institute of Molecular and Translational Cardiology (IMTC), San Donato Milanese, Milan, Italy
| | - Cheng-I Wu
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Michelle M Monasky
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Hao Xia
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Bian Li
- Department of Biological Sciences and Center for Structural Biology, Vanderbilt University, Nashville, TN, USA
| | - John A Capra
- Bakar Computational Health Sciences Institute and Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Kai Guo
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhong-He Zhang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Xiu Chen
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Bo Yang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Hong Jiang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China; Kent and Medway Medical School, Canterbury, Kent, United Kingdom; School of Nursing and Health Studies, Metropolitan University, Hong Kong, China
| | - Chloe Miu Mak
- Department of Pathology, Hong Kong Children's Hospital, Hong Kong, China
| | - Yoshiyasu Aizawa
- Department of Cardiovascular Medicine, International University of Health and Welfare, School of Medicine, 4-3, Kozunomori, Narita, Chiba, Japan
| | - Michael H Gollob
- Department of Physiology and Division of Cardiology, University of Toronto, Toronto, ON, Canada
| | - Charles Antzelevitch
- Lankenau Institute for Medical Research and Lankenau Heart Institute, Wynnwood, PA, USA; Jefferson Medical College, Philadelphia, PA, USA
| | - Arthur A M Wilde
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Carlo Pappone
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy; Vita-Salute San Raffaele University, Milan, Italy; Institute of Molecular and Translational Cardiology (IMTC), San Donato Milanese, Milan, Italy
| | - Dan Hu
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China.
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 874] [Impact Index Per Article: 437.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Bergamo D, Nelson C. Brugada pattern in adolescent with acute myocarditis due to SARS-CoV-2. J Am Coll Emerg Physicians Open 2022; 3:e12810. [PMID: 36176505 PMCID: PMC9474391 DOI: 10.1002/emp2.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 12/03/2022] Open
Abstract
Brugada syndrome is a genetic disorder characterized by abnormal findings on electrocardiogram (ECG) that can precipitate ventricular tachyarrhythmias and sudden cardiac death. Most clinical manifestations of Brugada syndrome are related to life-threatening tachyarrhythmias, such as ventricular fibrillation or polymorphic ventricular tachycardia, but Brugada syndrome can also present with syncope or less likely palpitations. Our case is of a previously healthy 17-year-old visiting from Puerto Rico who presented to the emergency department (ED) with a syncopal episode preceded by sore throat, dizziness, and lightheadedness without palpitations. The ED evaluation found a normal complete blood count and basic metabolic panel. The patient tested positive for COVID-19 by polymerase chain reaction. An ECG was performed that showed the Brugada pattern, which was later confirmed by cardiology. Although Brugada syndrome and pattern are well known to the medical population, the findings of Brugada pattern in the setting of COVID-19 is not well described. Recognition and treatment are important, as Brugada syndrome can lead to life-threatening arrhythmias and sudden cardiac death.
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Affiliation(s)
- David Bergamo
- Department of Pediatric Emergency MedicineNemours Children's Hospital DelawareWilmingtonDelawareUSA
| | - Courtney Nelson
- Department of Pediatric Emergency MedicineNemours Children's Hospital DelawareWilmingtonDelawareUSA
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Ideishi A, Nagase S, Kawamoto N, Fukushima S, Fujita T, Kusano K. Manifestation of epicardial type 1 electrocardiogram pattern with temperature elevation during open chest surgery in a patient with Brugada syndrome. HeartRhythm Case Rep 2022; 8:650-654. [PMID: 36147723 PMCID: PMC9485773 DOI: 10.1016/j.hrcr.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Nakamura H, Sato Y, Ishii R, Araki Y. A successfully treated Brugada syndrome presenting in ventricular fibrillation preceded by fever and concomitant hypercalcemia. Turk J Emerg Med 2022; 22:163-165. [PMID: 35936950 PMCID: PMC9355071 DOI: 10.4103/2452-2473.348439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/04/2022] Open
Abstract
Brugada syndrome (BS) is a genetic channelopathy syndrome that causes fatal cardiac dysrhythmias and sudden death. Fever and antiarrhythmics are aggravating factors of BS. There are many reports about BS preceded by fever but fewer reports on BS caused by hypercalcemia (HC). Here, we describe a unique case of BS preceded by concurrent fever and HC. A 46-year-old male visited the emergency department for malaise and fever. During admission, he suddenly developed cardiac arrest and ventricular fibrillation (VF). After resuscitation, electrocardiogram (ECG) showed "coved-type" ST elevation in V1 and V2, which led to the diagnosis of BS. This ST change declined after the fever subsided. He also had HC at the same time. After admission, he developed septic shock. We started treatment assuming that it was caused by the aggravation of ulcerative colitis, and liver abscess was revealed on contrast-enhanced computed tomography. After the infection was controlled, we implanted an implantable cardioverter defibrillator (ICD) and he was discharged. The cause of HC appeared to be an ectopic parathyroid adenoma, and calcium was normalized after tumor resection. In addition, this patient had nonfunctional pituitary adenoma and a nonfunctional adrenal tumor. His condition was indicative of multiple endocrine neoplasia type 1. This patient had BS presenting as VF induced by fever due to liver abscess and early repolarization, increasing the risk of arrhythmic events to carry out ICD implantation. HC can contribute to induce arrhythmia.
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Affiliation(s)
- Hiroki Nakamura
- Department of Emergency Medicine, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Yoshikazu Sato
- Department of Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Ryoko Ishii
- Endocrinology and Metabolism, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Yuichi Araki
- Department of Emergency Medicine, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
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Samavedam S. Sepsis and the Heart: More to Learn. Indian J Crit Care Med 2022; 26:775-777. [PMID: 36864865 PMCID: PMC9973167 DOI: 10.5005/jp-journals-10071-24262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Samavedam S. Sepsis and the Heart: More to Learn. Indian J Crit Care Med 2022;26(7):775-777.
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Affiliation(s)
- Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India
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28
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Wang M, Tu X. The Genetics and Epigenetics of Ventricular Arrhythmias in Patients Without Structural Heart Disease. Front Cardiovasc Med 2022; 9:891399. [PMID: 35783865 PMCID: PMC9240357 DOI: 10.3389/fcvm.2022.891399] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/25/2022] [Indexed: 12/19/2022] Open
Abstract
Ventricular arrhythmia without structural heart disease is an arrhythmic disorder that occurs in structurally normal heart and no transient or reversible arrhythmia factors, such as electrolyte disorders and myocardial ischemia. Ventricular arrhythmias without structural heart disease can be induced by multiple factors, including genetics and environment, which involve different genetic and epigenetic regulation. Familial genetic analysis reveals that cardiac ion-channel disorder and dysfunctional calcium handling are two major causes of this type of heart disease. Genome-wide association studies have identified some genetic susceptibility loci associated with ventricular tachycardia and ventricular fibrillation, yet relatively few loci associated with no structural heart disease. The effects of epigenetics on the ventricular arrhythmias susceptibility genes, involving non-coding RNAs, DNA methylation and other regulatory mechanisms, are gradually being revealed. This article aims to review the knowledge of ventricular arrhythmia without structural heart disease in genetics, and summarizes the current state of epigenetic regulation.
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Santoro F, Crea P, Pellegrino PL, Cetera R, Gianfrancesco D, Abumayyaleh M, Giuseppe D, Allegra M, Mancini N, D'Arienzo G, Mȕgge A, Aweimer A, Bartolomucci F, Akin I, El-Battrawy I, Brunetti ND. Fever following Covid-19 vaccination in subjects with Brugada syndrome: Incidence and management. J Cardiovasc Electrophysiol 2022; 33:1874-1879. [PMID: 35695789 PMCID: PMC9350146 DOI: 10.1111/jce.15596] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/08/2022] [Accepted: 06/07/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Fever is a potential side effect of the Covid-19 vaccination. Patients with Brugada syndrome (BrS) have an increased risk of life-threatening arrhythmias when experiencing fever. Prompt treatment with antipyretic drugs is suggested in these patients. AIM OF THE STUDY To evaluate the incidence and management of fever within 48 h from Covid-19 vaccination among BrS patients. METHODS One hundred sixty-three consecutive patients were enrolled in a prospective registry involving five European hospitals with a dedicated inherited disease ambulatory. RESULTS The mean age was 50 ± 14 years and 121 (75%) patients were male. Prevalence of Brugada electrocardiogram (ECG) pattern type-1, -2, and -3 was 32%, 44%, and 24%, respectively. Twenty-eight (17%) patients had an implantable cardioverter-defibrillator (ICD). Fever occurred in 32 (19%) BrS patients after 16 ± 10 h from vaccination, with a peak of body temperature of 37.9° ± 0.5°. Patients with fever were younger (39 ± 13 vs. 48 ± 13 years, p = .04). No additional differences in terms of sex and cardiovascular risk factors were found between patients with fever and not. Twenty-seven (84%) out of 32 patients experienced mild fever and five (16%) moderate fever. Pharmacological treatment with antipyretic drugs was required in 18 (56%) out of 32 patients and was associated with the resolution of symptoms. No patient required hospital admission and no arrhythmic episode was recorded in patients with ICD within 48 h after vaccination. No induced type 1 BrS ECG pattern and new ECG features were found among patients with moderate fever. CONCLUSION Fever is a common side effect in BrS patients after the Covid-19 vaccination. Careful evaluation of body temperature and prompt treatment with antipyretic drugs may be needed.
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Affiliation(s)
- Francesco Santoro
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Pasquale Crea
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Policlinico G. Martino, Messina, Italy
| | | | - Rosa Cetera
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | | | - Dattilo Giuseppe
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Policlinico G. Martino, Messina, Italy
| | - Marta Allegra
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Policlinico G. Martino, Messina, Italy
| | - Nastasia Mancini
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Policlinico G. Martino, Messina, Italy
| | - Girolamo D'Arienzo
- Department of Cardiology, Policlinico Riuniti, University Hospital, Foggia, Italy
| | - Andreas Mȕgge
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Assem Aweimer
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | | | - Ibrahim Akin
- Department of Cardiology, University of Mannheim, Mannheim, Germany
| | - Ibrahim El-Battrawy
- Department of Cardiology, University of Mannheim, Mannheim, Germany.,Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
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Brugada P, Wu CI, Wilde A, Baranchuk A, Alexander B, Miranda-Arboleda A. Exploring Coronavirus Disease 2019 and Brugada Syndrome. J Innov Card Rhythm Manag 2022; 13:5025-5028. [PMID: 35765581 PMCID: PMC9221187 DOI: 10.19102/icrm.2022.130607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Zimmermann P, Aberer F, Braun M, Sourij H, Moser O. The Arrhythmogenic Face of COVID-19: Brugada ECG Pattern in SARS-CoV-2 Infection. J Cardiovasc Dev Dis 2022; 9:jcdd9040096. [PMID: 35448072 PMCID: PMC9027624 DOI: 10.3390/jcdd9040096] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 12/15/2022] Open
Abstract
In 1992, Brugada syndrome (BS) was first described; an often unrecognized cardiac conduction disorder mainly associated with unexplained sudden cardiac arrest and consecutive syncope. Nevertheless, the pathomechanism of BS and sudden cardiac death remains mainly explained. Mutations in the cardiac sodium channels, which cause a reduction or functional loss of these channels, are associated with characteristic electrocardiographic (ECG) abnormalities and malignant arrhythmia. The majority of affected people are previously healthy and unaware of their genetic predisposition for BS and might experience ventricular tachyarrhythmias and cardiac arrest potentially triggered by several factors (e.g., alcohol, sodium channel blockers, psychotropic drugs, and fever). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was firstly identified in Wuhan in early December 2019 and rapidly spread worldwide as coronavirus disease (COVID-19). COVID-19 is typically characterized by a severe inflammatory response, activation of the immune system, and high febrile illness. Due to this condition, symptomatic COVID-19 infection or vaccination might serve as inciting factor for unmasking the Brugada pattern and represents a risk factor for developing proarrhythmic complications. The aim of this narrative review was to detail the association between virus-related issues such as fever, electrolyte disturbance, and inflammatory stress of COVID-19 infection with transient Brugada-like symptoms and ECG-pattern and its susceptibility to proarrhythmogenic episodes.
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Affiliation(s)
- Paul Zimmermann
- Department of Sport Science, Division of Exercise Physiology and Metabolism, University of Bayreuth, 95447 Bayreuth, Germany; (P.Z.); (O.M.)
- Department of Cardiology, Klinikum Bamberg, 96049 Bamberg, Germany;
| | - Felix Aberer
- Department of Sport Science, Division of Exercise Physiology and Metabolism, University of Bayreuth, 95447 Bayreuth, Germany; (P.Z.); (O.M.)
- Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria;
- Correspondence: ; Tel.: +43-316-385-86113
| | - Martin Braun
- Department of Cardiology, Klinikum Bamberg, 96049 Bamberg, Germany;
| | - Harald Sourij
- Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria;
| | - Othmar Moser
- Department of Sport Science, Division of Exercise Physiology and Metabolism, University of Bayreuth, 95447 Bayreuth, Germany; (P.Z.); (O.M.)
- Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria;
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Krahn AD, Behr ER, Hamilton R, Probst V, Laksman Z, Han HC. Brugada Syndrome. JACC Clin Electrophysiol 2022; 8:386-405. [PMID: 35331438 DOI: 10.1016/j.jacep.2021.12.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 12/15/2022]
Abstract
Brugada syndrome (BrS) is an "inherited" condition characterized by predisposition to syncope and cardiac arrest, predominantly during sleep. The prevalence is ∼1:2,000, and is more commonly diagnosed in young to middle-aged males, although patient sex does not appear to impact prognosis. Despite the perception of BrS being an inherited arrhythmia syndrome, most cases are not associated with a single causative gene variant. Electrocardiogram (ECG) findings support variable extent of depolarization and repolarization changes, with coved ST-segment elevation ≥2 mm and a negative T-wave in the right precordial leads. These ECG changes are often intermittent, and may be provoked by fever or sodium channel blocker challenge. Growing evidence from cardiac imaging, epicardial ablation, and pathology studies suggests the presence of an epicardial arrhythmic substrate within the right ventricular outflow tract. Risk stratification aims to identify those who are at increased risk of sudden cardiac death, with well-established factors being the presence of spontaneous ECG changes and a history of cardiac arrest or cardiogenic syncope. Current management involves conservative measures in asymptomatic patients, including fever management and drug avoidance. Symptomatic patients typically undergo implantable cardioverter defibrillator insertion, with quinidine and epicardial ablation used for patients with recurrent arrhythmia. This review summarizes our current understanding of BrS and provides clinicians with a practical approach to diagnosis and management.
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Affiliation(s)
- Andrew D Krahn
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group and Cardiology Research Centre, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Robert Hamilton
- Department of Pediatrics (Cardiology), The Labatt Family Heart Centre and Translational Medicine, The Hospital for Sick Children & Research Institute and the University of Toronto, Toronto, Canada
| | - Vincent Probst
- Cardiologic Department and Reference Center for Hereditary Arrhythmic Diseases, Nantes University Hospital, Nantes, France
| | - Zachary Laksman
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hui-Chen Han
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
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Ferreira AC, Dias‐Filho CAA, Jesus Silva Soares Junior N, Dias CJ, Monteiro SCM, Andrade RM, Mostarda CT. Phenotypes of mutations related to voltage‐dependent sodium channels on children and adolescents. J Biochem Mol Toxicol 2022; 36:e22993. [DOI: 10.1002/jbt.22993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 11/30/2021] [Accepted: 01/04/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Andressa Coelho Ferreira
- Laboratory of Cardiovascular Adaptations to Exercise—LACORE, Physical Education Department University Federal of Maranhão São Luís Brazil
| | - Carlos Alberto Alves Dias‐Filho
- Laboratory of Cardiovascular Adaptations to Exercise—LACORE, Physical Education Department University Federal of Maranhão São Luís Brazil
| | - Nivaldo Jesus Silva Soares Junior
- Laboratory of Cardiovascular Adaptations to Exercise—LACORE, Physical Education Department University Federal of Maranhão São Luís Brazil
| | - Carlos José Dias
- Laboratory of Cardiovascular Adaptations to Exercise—LACORE, Physical Education Department University Federal of Maranhão São Luís Brazil
- Physical Education Department UFMA Sao Luis Brazil
| | - Sally Cristina Moutinho Monteiro
- Laboratory of Cardiovascular Adaptations to Exercise—LACORE, Physical Education Department University Federal of Maranhão São Luís Brazil
- Pharmacy Department UFMA Sao Luis Brazil
| | - Rafael Martins Andrade
- Laboratory of Cardiovascular Adaptations to Exercise—LACORE, Physical Education Department University Federal of Maranhão São Luís Brazil
| | - Cristiano Teixeira Mostarda
- Laboratory of Cardiovascular Adaptations to Exercise—LACORE, Physical Education Department University Federal of Maranhão São Luís Brazil
- Pharmacy Department UFMA Sao Luis Brazil
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Attard A, Stanniland C, Attard S, Iles A, Rajappan K. Brugada syndrome: should we be screening patients before prescribing psychotropic medication? Ther Adv Psychopharmacol 2022; 12:20451253211067017. [PMID: 35111298 PMCID: PMC8801628 DOI: 10.1177/20451253211067017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022] Open
Abstract
Brugada syndrome (BrS) presents with a characteristic electrocardiogram (ECG) and is associated with sudden cardiac death. Until now, prolongation of QTc interval and its association with Torsade de Pointe and possible fatal arrhythmia have been the focus of routine baseline ECGs before prescribing psychotropic medication. A semi-systematic literature review was conducted using PubMed. The terms 'Brugada', 'Brugada Syndrome' AND 'psychotropic' 'antipsychotic' 'antidepressant' 'mood stabilisers' 'clozapine' 'Tricyclic Antidepressants' 'Lithium' were searched. From a search that delivered over 200 articles, 82 articles were included. Those that included details around causative medication, doses of medication and where clear timeline on drug cause were included. Where clarification was needed, the manufacturer of the medication was contacted directly. Psychotropic medication can be associated with BrS, Brugada phenocopy or unmasking of BrS, in overdose or in normal doses. Our results include a table summarising a number of psychotropic overdoses that led to BrS unmasking. Routine screening for BrS in patients before prescribing psychotropic medication is a natural extension of the baseline ECG currently routinely done to rule out QTc prolongation. Psychiatrists need to invest in ensuring better skills in interpreting ECGs and work closer with cardiologists in interpreting ECGs.
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Affiliation(s)
- Azizah Attard
- Department of Pharmacy, West London NHS Trust, Southall UB1 3EUN2 PCN, Virtually Healthcare, London
| | | | - Stephen Attard
- Central and North West London NHS Foundation Trust, London, UK
| | - Andrew Iles
- Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, UK
| | - Kim Rajappan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Ayad S, Alyacoub R, Gergis K, Noori MAM, Elkattawy S, Abdelazeem B, Pullatt R. Fever and Hyponatremia Unmasking Brugada Pattern Electrocardiogram in a Patient With SARS-CoV-2 Infection. Cureus 2021; 13:e18578. [PMID: 34760421 PMCID: PMC8572016 DOI: 10.7759/cureus.18578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/15/2022] Open
Abstract
Brugada syndrome is an autosomal dominant genetic disorder that primarily affects myocardial sodium channels and has been associated with an increased risk of ventricular tachyarrhythmias and sudden cardiac death. Here, we report a case of a 58-year-old Hispanic male with a history significant for prior pulmonary tuberculosis infection who presented with pleuritic left-sided chest pain associated with body aches, productive cough, fevers, and chills and was found to be positive for SARS-CoV-2 by real-time reverse-transcription-polymerase chain reaction (rRT-PCR). Electrocardiogram (ECG, EKG) on presentation demonstrated a coved ST-segment elevation in V1-V2, suggesting Brugada pattern type 1 without evidence of ischemic changes. EKG changes normalized once fever and hyponatremia improved.
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Affiliation(s)
- Sarah Ayad
- Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Ramez Alyacoub
- Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | | | - Muhammad Atif Masood Noori
- Internal Medicine, Dow Medical College, Karachi, PAK.,Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Sherif Elkattawy
- Internal Medicine, Trinitas Regional Medical Center, Elizabeth, USA
| | - Basel Abdelazeem
- Internal Medicine, McLaren Health Care, Michigan State University, Flint, USA
| | - Raja Pullatt
- Cardiology, Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
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36
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Wang L, Zhao Y, Ma L. Case Report: Coexistent Wolff-Parkinson-White Syndrome and Brugada Phenocopy in a Patient With Pneumonia and Myocarditis. Front Cardiovasc Med 2021; 8:711364. [PMID: 34746247 PMCID: PMC8566699 DOI: 10.3389/fcvm.2021.711364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/24/2021] [Indexed: 12/01/2022] Open
Abstract
Background: In recent years, Wolff-Parkinson-White (WPW) syndrome and Brugada electrocardiogram (ECG) patterns have been reported as coexistent in the same patient. In most cases, the two waveforms appeared separately. Here, we described combinations of different waveforms on one ECG, such as the Brugada pattern with delta waves and the Brugada pattern with paroxysmal supraventricular tachycardia (PSVT). Importantly, we recorded an alternate conversion of these combined ECG waveforms, which has not previously been reported in the literature. At the same time, we confirmed that the change in the waveform was related to fever by analyzing Holter data. Case: A 48-year-old male was admitted to our hospital due to palpitations and fever. The patient had a history of a cold 3 days ago. Laboratory examinations showed an elevated neutrophil percentage (85%) and troponin I level (0.86 ng/ml). A chest computed tomography (CT) scan showed inflammation in the right lung. The diagnosis of pneumonia and myocarditis was made. ECG indicated WPW syndrome and the Brugada pattern. We recorded the dynamic changes in this combination of delta waves and Brugada waves with a Holter monitor, and we found the changes would happen when the patient's body temperature rose. The doctors thought that the patient's pulmonary infection led to fever, which caused the changes in waveform. After treatment with antibacterial therapy and supportive care, his body temperature returned to normal. The various laboratory indicators also gradually returned to normal. The doctor recommended that the patient undergo further pre-excitation bypass radiofrequency ablation treatment, but the patient refused and was discharged. Conclusion: Delta waves and Brugada ECG patterns could appear on one ECG at the same time. There were dynamic changes of QRS complex, relating to fever.
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Affiliation(s)
- Li Wang
- Department of Electrocardiogram Diagnosis, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yana Zhao
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lan Ma
- Department of Electrocardiogram Diagnosis, Second Affiliated Hospital of Anhui Medical University, Hefei, China
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37
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Long-Term Prognosis of Febrile Individuals with Right Precordial Coved-Type ST-Segment Elevation Brugada Pattern: A 10-Year Prospective Follow-Up Study. J Clin Med 2021; 10:jcm10214997. [PMID: 34768515 PMCID: PMC8584636 DOI: 10.3390/jcm10214997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022] Open
Abstract
A febrile state may provoke a Brugada electrocardiogram (ECG) pattern and trigger ventricular tachyarrhythmias in susceptible individuals. However, the prognostic value of fever-induced Brugada ECG pattern remains unclear. We analyzed the clinical and extended long-term follow-up data of consecutive febrile patients with a type 1 Brugada ECG presented to the emergency department. A total of 21 individuals (18 males; mean age, 43.7 ± 18.6 years at diagnosis) were divided into symptomatic (resuscitated cardiac arrest in one, syncope in two) and asymptomatic (18, 86%) groups. Sustained polymorphic ventricular tachycardias were inducible in two patients with previous syncope. All 18 asymptomatic patients had no spontaneous type 1 Brugada ECG recorded at second intercostal space and no family history of sudden death. Among asymptomatic individuals, 4 had a total 12 of repeated non-arrhythmogenic febrile episodes all with recurrent type 1 Brugada ECGs, and none had a ventricular arrhythmic event during 116 ± 19 months of follow-up. In the symptomatic group, two had defibrillator shocks for a new arrhythmic event at 31- and 49 months follow-up, respectively, and one without defibrillator therapy died suddenly at 8 months follow-up. A previous history of aborted sudden death or syncope was significantly associated with adverse outcomes in symptomatic compared with asymptomatic individuals (log-rank p < 0.0001). In conclusion, clinical presentation or history of syncope is the most important parameter in the risk stratification of febrile patients with type 1 Brugada ECG. Asymptomatic individuals with a negative family history of sudden death and without spontaneous type 1 Brugada ECG, have an exceptionally low future risk of arrhythmic events. Careful follow-up with timely and aggressive control of fever is an appropriate management option.
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38
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Abstract
Brugada syndrome (BrS) is an inherited cardiac arrhythmia syndrome that causes a heightened risk for ventricular tachyarrhythmias and sudden cardiac death. BrS is characterised by a coved ST-segment elevation in right precordial leads. The prevalence is estimated to range between 1 in 5,000 to 1 in 2,000 in different populations, with the highest being in Southeast Asia and in males. More than 18 genes associated with BrS have been discovered and recent evidence has suggested a complex polygenic mode of inheritance with multiple common and rare genetic variants acting in concert to produce the BrS phenotype. Diagnosis of BrS in patients currently relies on presentation with a type-1 Brugada pattern on ECG either spontaneously or following a drug provocation test using a sodium channel blocker. Risk assessment in patients diagnosed with BrS is controversial, especially with regard to the predictive value of programmed electrical stimulation and novel ECG parameters, such as QRS fragmentation. The first line of BrS therapy remains an implantable cardioverter defibrillator (ICD), although radiofrequency catheter ablation has been shown to be an effective option in patients with contraindications for an ICD. True BrS can be unmasked on ECG in susceptible individuals by monitoring factors such as fever, and this has been recently evident in several patients infected with the 2019 novel coronavirus (COVID-19). Aggressive antipyretic therapy and regular ECG monitoring until fever resolves are current recommendations to help reduce the arrhythmic risk in these COVID-19 patients. In this review, we summarise the current knowledge on the epidemiology, pathophysiology, genetics, clinical diagnosis, risk stratification and treatment of patients with BrS, with special emphasis on COVID-19 comorbidity.
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Affiliation(s)
| | - Giridhar Korlipara
- Cardiology Division of Department of Medicine, Renaissance School of Medicine, Stony Brook Medical Center, Stony Brook, NY, USA
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39
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Kaur T, Sriram CS, Kohli U. Extreme hyperthermia-induced arrhythmogenesis. Cardiol Young 2021; 32:1-4. [PMID: 34583804 DOI: 10.1017/s1047951121003978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Hyperthermia is defined as an elevated body temperature above the normal range due to a failure of heat regulatory mechanisms. In addition to its effects on other organ systems, hyperthermia is associated with profound cardiovascular effects. We report the sentinel case of a 6-year-old girl with structurally and electrically normal heart, who presented with life-threatening hyperpyrexia-induced ventricular tachycardia, which was refractory to cardioversion and anti-arrhythmics but responded promptly to cooling. We emphasise the lifesaving role of immediate and aggressive cooling in such patients.
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Affiliation(s)
- Tripat Kaur
- Department of Pediatrics, Comer Children's Hospital, Chicago, IL, USA
| | - Chenni S Sriram
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA
| | - Utkarsh Kohli
- Department of Pediatrics, Comer Children's Hospital, Chicago, IL, USA
- The Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
- Division of Pediatric Cardiology, Department of Pediatrics, West Virginia University Children's Hospital, Morgantown, WV, USA
- West Virginia University School of Medicine, Morgantown, WV, USA
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40
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Sigmundsson F, Kuchalik J, Fadl S, Holy M, Joelson A. The unique challenges of Brugada syndrome in spinal deformity surgery. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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41
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Caturano A, Pafundi PC, Sasso FC, Dendramis G, Brugada P, Russo V. Brugada syndrome and COVID-19 vaccines. Europace 2021; 23:1871-1872. [PMID: 34383900 PMCID: PMC8385984 DOI: 10.1093/europace/euab211] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/16/2021] [Indexed: 01/25/2023] Open
Affiliation(s)
- Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, IT-80138 Naples, Italy
| | - Pia Clara Pafundi
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, IT-80138 Naples, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, IT-80138 Naples, Italy
| | - Gregory Dendramis
- Department of Cardiology, ARNAS Ospedale Civico e Benfratelli, Palermo, Italy.,Department of Cardiology, Heart Rhythm Managment Centre, UZ Brussel-VUB, Brussels, Belgium
| | - Pedro Brugada
- Department of Cardiology, Heart Rhythm Managment Centre, UZ Brussel-VUB, Brussels, Belgium
| | - Vincenzo Russo
- Division of Cardiology, Department of Medical Translational Sciences, Monaldi Hospital, University of Campania "Luigi Vanvitelli" Naples, Italy
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42
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Adedeji OM, Falk Z, Tracy CM, Batarseh A. Brugada pattern in an afebrile patient with acute COVID-19. BMJ Case Rep 2021; 14:e242632. [PMID: 34257116 PMCID: PMC8278894 DOI: 10.1136/bcr-2021-242632] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 11/24/2022] Open
Abstract
COVID-19 has been associated with significant risk for cardiac arrhythmias, particularly in patients with underlying cardiac conditions or prior histories of arrhythmia. It has been shown that a Brugada pattern can be unmasked in febrile patients with COVID-19. Herein we report a unique case of an afebrile patient without known prior history of Brugada presenting with Brugada pattern on ECG.
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Affiliation(s)
- Omowunmi M Adedeji
- Internal Medicine, The George Washington University Hospital, Washington, DC, USA
| | - Zachary Falk
- Internal Medicine, The George Washington University Hospital, Washington, DC, USA
| | - Cynthia M Tracy
- Cardiology, The George Washington University Hospital, Washington, DC, USA
| | - Alberto Batarseh
- Internal Medicine, The George Washington University Hospital, Washington, DC, USA
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43
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Behr ER, Ben-Haim Y, Ackerman MJ, Krahn AD, Wilde AAM. Brugada syndrome and reduced right ventricular outflow tract conduction reserve: a final common pathway? Eur Heart J 2021; 42:1073-1081. [PMID: 33421051 DOI: 10.1093/eurheartj/ehaa1051] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/04/2020] [Accepted: 12/09/2020] [Indexed: 12/19/2022] Open
Abstract
Brugada syndrome (BrS) was first described as a primary electrical disorder predisposing to the risk of sudden cardiac death and characterized by right precordial lead ST elevation. Early description of right ventricular structural abnormalities and of right ventricular outflow tract (RVOT) conduction delay in BrS patients set the stage for the current controversy over the pathophysiology underlying the syndrome: channelopathy or cardiomyopathy; repolarization or depolarization. This review examines the current understanding of the BrS substrate, its genetic and non-genetic basis, theories of pathophysiology, and the clinical implications thereof. We propose that the final common pathway for BrS could be viewed as a disease of 'reduced RVOT conduction reserve'.
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Affiliation(s)
- Elijah R Behr
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's University of London, Cranmer Terrace, London SW17 0RE, UK.,St. George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart (ERN GUARDHEART http://guardheart.ern-net.eu).,European Cardiac Arrhythmia Genetics Focus Group (ECGen), EHRA
| | - Yael Ben-Haim
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's University of London, Cranmer Terrace, London SW17 0RE, UK.,St. George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart (ERN GUARDHEART http://guardheart.ern-net.eu)
| | - Michael J Ackerman
- Division of Heart Rhythm Services and the Windland Smith Rice Genetic Heart Rhythm Clinic, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Andrew D Krahn
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - Arthur A M Wilde
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart (ERN GUARDHEART http://guardheart.ern-net.eu).,European Cardiac Arrhythmia Genetics Focus Group (ECGen), EHRA.,Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
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44
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Connolly GM, Sammut E, Carpenter A, Nisbet A. Importance of thorough investigation in a patient presenting with recurrent collapse and ST elevation. BMJ Case Rep 2021; 14:14/2/e238057. [PMID: 33547120 PMCID: PMC7871265 DOI: 10.1136/bcr-2020-238057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
There is increasing literature to suggest numerous subgroups of Brugada syndrome (BrS), including those with ST elevation in the lateral or inferior leads. We present a case of a patient presenting with recurrent collapse and inferior ST elevation degenerating to ventricular fibrillation and ultimately leading to a diagnosis of BrS.
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Affiliation(s)
- Georgia May Connolly
- University of Bristol, Bristol, UK,Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Eva Sammut
- University of Bristol, Bristol, UK,Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Alexander Carpenter
- University of Bristol, Bristol, UK,Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Ashley Nisbet
- Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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45
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Gene expression profile in cases of infectious death in infancy. Pediatr Res 2021; 89:483-487. [PMID: 32299088 DOI: 10.1038/s41390-020-0896-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 03/23/2020] [Accepted: 04/01/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Genetic predispositions in cases suffering sudden unexpected infant death have been a research focus worldwide during the past decade. Despite large efforts, there is still uncertainty concerning the molecular pathogenesis of these deaths. With genetic technology in constant development, the possibility of an alternative approach into this research field has become available, like mRNA expression studies. METHODS In this study, we investigated mRNA gene expression in 14 cases who died suddenly and unexpectedly from infection without a history of severe illness prior to death. The control group included eight accidents, two cases of natural death, one undetermined, one case of medical malpractice, and two homicides. The study included tissue from liver, heart, and brain using Illumina whole-genome gene expression assay. RESULTS From the array, 19 genes showed altered expression in the infectious deaths compared to controls. Tissue from the heart showed 15 genes with altered mRNA expression compared to the control group. CONCLUSIONS Downregulation of KCNE5 in heart tissue from cases of infectious death was of particular interest. Variants of KCNE5 are associated with Brugada syndrome and sudden death and could be responsible for the fatal outcome in the group of infectious death. IMPACT KCNE5 is downregulated in tissue from the heart in cases of infectious death in infancy. This study provides knowledge about the gene expression profile in cases of infectious death. Variants of a gene known to give increased risk of cardiac arrhythmia is downregulated in cases of infectious death in infancy. The results could give us better knowledge as to why some infants do not survive an infection. This study provides a candidate gene for future studies.
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46
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Bates A, Ullah W, Wilkinson J, Shambrook J. Two zebras and a cardiac arrest: a case report of concomitant Brugada syndrome and an anomalous coronary artery. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-6. [PMID: 33447719 PMCID: PMC7793225 DOI: 10.1093/ehjcr/ytaa425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/28/2020] [Accepted: 10/11/2020] [Indexed: 11/18/2022]
Abstract
Background Discovering concomitant diagnoses results in a challenge to determine the true cause of a patient’s presentation. Evaluating this fully is vital to plan appropriate and avoid inappropriate therapy. Case summary A 55-year-old gentleman presents in cardiac arrest whilst watching an unusual occurrence of England dominating a Football World Cup game vs. Panama in 2018. Diagnostic coronary angiography discovered an anomalous right coronary artery from the opposite sinus (R-ACAOS), but clinical suspicion this was incidental lead to a further diagnosis of Type 1 Brugada Syndrome (BrS) following a positive Ajmaline provocation challenge. Risk stratification of these two zebras using computed tomography coronary angiography (CTCA), Cardiac magnetic resonance imaging (CMRI), Exercise Stress Echocardiography was performed and following a multi-disciplinary meeting, BrS was felt to be the primary diagnosis. The patient received a secondary prevention implantation of a cardiac defibrillator and avoided cardiac surgery. Discussion Diagnosing a rare condition does not necessarily mean it is the cause of a patient’s presentation and should not end the investigative process. Right coronary artery from the opposite sinus rarely causes cardiac arrest in middle age and is typically associated with peak exercise. Type 1 BrS is associated with cardiac arrest with vagal activity, perhaps such as England winning a World Cup game! Clinical correlation and risk stratification is required for suspected incidental findings.
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Affiliation(s)
- Alexander Bates
- Department of Cardiology, E Level, North Wing, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Waqas Ullah
- Department of Cardiology, E Level, North Wing, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - James Wilkinson
- Department of Cardiology, E Level, North Wing, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - James Shambrook
- Department of Cardiothoracic Radiology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
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47
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Nene RV, Tolia VM. Fever-Induced Brugada-Pattern Electrocardiogram. J Emerg Med 2020; 59:432-434. [PMID: 32814676 DOI: 10.1016/j.jemermed.2020.06.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/31/2020] [Accepted: 06/14/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Brugada syndrome is an increasingly recognized syndrome characterized by a particular electrocardiography (ECG) pattern and clinical criteria and has a high incidence of sudden death in patients with structurally normal hearts. The Brugada ECG pattern can be unmasked by drugs, ischemia, and fever. CASE REPORT We present the case of a 47-year-old man who presented to the emergency department with flu-like symptoms and syncope. On arrival, he was febrile and his ECG showed a Brugada pattern. Although this pattern resolved once his fever resolved, the cardiologists were concerned that his syncopal episode might have been due to ventricular tachycardia/fibrillation, and the patient was admitted for implantable cardiac defibrillator placement. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Fever and other stressors can unmask a Brugada pattern on ECG, and if patients have concerning clinical criteria, they should receive emergent cardiology follow-up.
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Affiliation(s)
- Rahul V Nene
- Department of Emergency Medicine, University of California-San Diego, San Diego, California
| | - Vaishal M Tolia
- Department of Emergency Medicine, University of California-San Diego, San Diego, California
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48
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Tsimploulis A, Rashba EJ, Rahman T, Almasry IO, Singh A, Fan R. Medication unmasked Brugada syndrome and cardiac arrest in a COVID-19 patient. HeartRhythm Case Rep 2020; 6:554-557. [PMID: 32837906 PMCID: PMC7245294 DOI: 10.1016/j.hrcr.2020.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Eric J Rashba
- State University Hospital of New York at Stony Brook, Stony Brook, New York
| | - Tahmid Rahman
- State University Hospital of New York at Stony Brook, Stony Brook, New York
| | - Ibrahim O Almasry
- State University Hospital of New York at Stony Brook, Stony Brook, New York
| | - Abhijeet Singh
- State University Hospital of New York at Stony Brook, Stony Brook, New York
| | - Roger Fan
- State University Hospital of New York at Stony Brook, Stony Brook, New York
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49
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Kim MS, Frenkel SL, Hayden SR. Fever Unmasking Brugada-Pattern Electrocardiogram in Patient With Coronavirus Disease 2019 (COVID-19). J Emerg Med 2020; 59:439-441. [PMID: 32739128 PMCID: PMC7293496 DOI: 10.1016/j.jemermed.2020.06.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/06/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Mi Song Kim
- Department of Emergency Medicine, San Diego Health, San Diego, California
| | - Sam L Frenkel
- Department of Emergency Medicine, San Diego Health, San Diego, California
| | - Stephen R Hayden
- Department of Emergency Medicine, San Diego Health, San Diego, California
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50
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Peltenburg PJ, Blom NA, Vink AS, Kammeraad JAE, Breur HJMPJ, Rammeloo LAJ, Wilde AAM, Clur SAB. In Children and Adolescents From Brugada Syndrome-Families, Only SCN5A Mutation Carriers Develop a Type-1 ECG Pattern Induced By Fever. Circulation 2020; 142:89-91. [PMID: 32628552 DOI: 10.1161/circulationaha.120.045720] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Puck J Peltenburg
- Department of Pediatric Cardiology, Emma Children's Hospital (P.J.P, N.A.B., A.S.V., S.-A.B.C.), Amsterdam University Medical Center, location Academic Medical Center (AMC), The Netherlands.,Heart Center (P.J.P., A.S.V., A.A.M.W.), Amsterdam University Medical Center, location Academic Medical Center (AMC), The Netherlands
| | - Nico A Blom
- Department of Pediatric Cardiology, Emma Children's Hospital (P.J.P, N.A.B., A.S.V., S.-A.B.C.), Amsterdam University Medical Center, location Academic Medical Center (AMC), The Netherlands.,Department of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Centre, The Netherlands (N.A.B.)
| | - Arja S Vink
- Department of Pediatric Cardiology, Emma Children's Hospital (P.J.P, N.A.B., A.S.V., S.-A.B.C.), Amsterdam University Medical Center, location Academic Medical Center (AMC), The Netherlands.,Heart Center (P.J.P., A.S.V., A.A.M.W.), Amsterdam University Medical Center, location Academic Medical Center (AMC), The Netherlands
| | - Janneke A E Kammeraad
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus University, Rotterdam, The Netherlands (J.A.E.K.)
| | - Hans J M P J Breur
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, UMC Utrecht, The Netherlands (H.J.M.P.J.B.)
| | - Lukas A J Rammeloo
- Department of Pediatric Cardiology, Amsterdam UMC, location Vrije Universiteit Medical Centre, The Netherlands (L.A.J.R.)
| | - Arthur A M Wilde
- Heart Center (P.J.P., A.S.V., A.A.M.W.), Amsterdam University Medical Center, location Academic Medical Center (AMC), The Netherlands
| | - Sally-Ann B Clur
- Department of Pediatric Cardiology, Emma Children's Hospital (P.J.P, N.A.B., A.S.V., S.-A.B.C.), Amsterdam University Medical Center, location Academic Medical Center (AMC), The Netherlands
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