Fever-induced Brugada pattern: How common is it and what does it mean?
Section snippets
Febrile and afebrile groups
Between January 2010 and August 2012, we prospectively collected ECG recordings of all febrile patients (defined as oral temperature >38°C [>100.4°F]) who were evaluated in our emergency medicine department. Because our hospital has a separate pediatric emergency room, only adults were studied. Also, to ensure that all patients presenting with fever in a given day were included in the study, we studied only those who presented to the emergency room during the morning shift of weekdays when
Results
ECG recordings from 402 febrile and 909 afebrile patients were compared. Febrile and afebrile patients were of similar age (62 ± 22 years vs 61 ± 19 years, P = NS), but males were overrepresented in the febrile group (60% vs 49%, P <.001).
Eight of 402 patients with fever, but only 1 of 909 afebrile patients, had a type I Brugada pattern (Figure 1). Thus, a type I Brugada pattern was 20 times more prevalent among febrile patients (2% vs 0.1%, P = .0001). The estimated 95% confidence intervals
Discussion
Fever-induced Brugada is the term used to describe the aggravation of clinical and/or ECG characteristics of this syndrome during febrile states in susceptible individuals. Although the existence of this phenomenon is well accepted, there is more than 1 proposed mechanism for its pathophysiology (see below). Moreover, little is known about the true prevalence of this phenomenon. Therefore, we studied consecutive febrile patients in order to learn how frequently fever exposes a type I Brugada
Conclusion
Our study shows that the prevalence of type I Brugada ECG in patients with fever is 20 times higher than in afebrile patients, emphasizing the potency of fever in uncovering this ECG phenomenon. These findings also may imply that the number of asymptomatic Brugada patients diagnosed today is only the tip of the iceberg, as many more would have been discovered if their ECGs were recorded during febrile illnesses. This has possible implications regarding the number of patients who are potentially
Acknowledgments
We are indebted to Shelly Piterman, Nina Volensky, Ribal Kashkush, and Zinaida Reiscin, who helped collect the ECGs for the study.
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