title: Fever as a precipitant of idiopathic ventricular fibrillation in patients with normal hearts.
abstract: BACKGROUND
  Ventricular fibrillation (VF) is the main mechanism of sudden cardiac death. The clinical precipitants of sudden cardiac death due to idiopathic VF are poorly characterized. Emerging evidence implicates triggers originating predominantly from the distal Purkinje arborization and the right ventricular outflow tract.
  
  
  RESULTS
  We report three patients without structural heart disease or repolarization abnormalities in whom a febrile illness was the only concurrent disease associated with unexpected sudden cardiac death due to VF storm. An automated defibrillator was implanted in all three patients. In one patient with persistent recurrent VF episodes, mapping demonstrated the origin of these triggers was from the Purkinje arborization of the anterior wall of the right ventricle. Ablation at a site of earliest activation during ectopy, where pace mapping was concordant and Purkinje potential preceded the onset of ventriculogram, resulted in suppression of all arrhythmias. After follow-up of 22, 9, and 18 months in the three patients, no ventricular arrhythmias have been recorded.
  
  
  CONCLUSIONS
  We present a series of patients in whom an apparently benign febrile illness was associated with malignant ventricular arrhythmias in the absence of cardiac disease or other factors known to precipitate sudden cardiac death. Physicians should be aware of this possible phenomenon in cases of febrile illness associated with syncope.
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux 2, Bordeaux, France. jl-pasquie@chu-montpellier.fr
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Pasquié
authors.forename: Prashanthan
authors.initials: P
authors.lastname: Sanders
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.forename: Li Fern
authors.initials: LF
authors.lastname: Hsu
authors.forename: Christophe
authors.initials: C
authors.lastname: Scavée
authors.forename: Pierre
authors.initials: P
authors.lastname: Jais
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Martin
authors.initials: M
authors.lastname: Rotter
authors.forename: Fréderic
authors.initials: F
authors.lastname: Sacher
authors.forename: Jacques
authors.initials: J
authors.lastname: Victor
authors.forename: Jacques
authors.initials: J
authors.lastname: Clémenty
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
mesh_terms: D000368:Aged; D016757:Death, Sudden, Cardiac; D017147:Defibrillators, Implantable; D004594:Electrophysiology; D005260:Female; D005334:Fever / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D014693:Ventricular Fibrillation / Q000209:etiology*