Electrocardiographic pattern of Brugada syndrome
disclosed by a febrile illness: clinical and
N. Patruno1, D. Pontillo2, A. Achilli2, G. Ruggeri1and G. Critelli3
1Department of Cardiology, S. Giuseppe Hospital, Albano Laziale, Rome, Italy;2Department of Cardiology,
Belcolle Hospital, Viterbo, Italy and3Department of Cardiology, University of Rome ‘La Sapienza’,
Via Ceresio 11, 00199 Rome, Italy
Background Recent studies have identified a direct link
between the ionic mechanisms responsible for the electro-
cardiographic (ECG) pattern of the Brugada syndrome
(BS) and the in vitro experimental temperature, pointing to
the possibility that some BS patients may display the ECG
phenotype only during a febrile state, being in this setting at
risk of lethal arrhythmias.
Case report A 53-year-old man referred to the emergency
room for abdominal pain and fever. The ECG showed
dome-shaped ST-segment elevation in V1–V3, as in the
typical BS. The personal and family history were un-
remarkable for syncope and sudden death and physical,
laboratory and ultrasound examinations were negative.
On day 3, at normal body temperature, the patient’s ECG
returned to normal and the ECG abnormalities were later
reproduced with intravenous flecainide. The patient refused
the implantation of a loop recorder and was discharged
after 6 days. He has remained asymptomatic during 2 years
Conclusions The typical ECG phenotype of BS disclosed
by a febrile illness confirms the in vitro experimental data
that previously established a correlation between ECG
pattern of BS and temperature variations. The clinical and
therapeutic implications of these findings are discussed.
(Europace 2003; 5: 251–255)
? 2003 The European Society of Cardiology. Published by
Elsevier Ltd. All rights reserved.
Key Words: Asymptomatic Brugada syndrome, fever,
The Brugada syndrome (BS) is a major cause of sudden
death in young men with no evidence of structural heart
disease. According to the original description, the
disease is electrocardiographically characterized by ST-
segment elevation in V1 through V3 coved, saddle-back
or dome-shaped, an apparent right bundle branch block
(RBBB), and rapid polymorphic ventricular tachycardia
capable of degenerating into ventricular fibrillation.
Moreover, there is the evidence that in patients with BS,
early repolarization abnormalities (prominent J wave)
and not RBBB represent the hallmark of the electro-
cardiographic (ECG) pattern. In most patients, the
typical widened S wave in lateral leads, commonly
observed in RBBB, is absent and the QRS duration is
Recently, the BS was linked to different mutations in
SCN5A, the gene encoding for the alpha subunit of the
cardiac sodium channel. In addition, it has been
demonstrated that the ionic mechanisms responsible for
the ECG phenotype of the disease are temperature
dependent, pointing to the possibility that some BS
patients may be at risk only during a febrile state.
In this paper we describe a patient with the typical
ECG pattern of BS disclosed by fever, and discuss the
Manuscript submitted 24 September 2002, and accepted after
revision 19 March 2003.
Correspondence: Giuseppe Critelli, MD, Via Ceresio 11, 00199
Rome, Italy. Tel.: (39) 0649976154; Fax: (39) 064453825; E-mail:
Europace (2003) 5, 251–255
? 2003 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.
by guest on September 15, 2015