Fever as a precipitant of idiopathic ventricular fibrillation in patients with normal hearts.
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.
Pasquié
Jean Luc
JL
Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux 2, Bordeaux, France. jl-pasquie@chu-montpellier.fr
Sanders
Prashanthan
P
Hocini
Mélèze
M
Hsu
Li Fern
LF
Scavée
Christophe
C
Jais
Pierre
P
Takahashi
Yoshihide
Y
Rotter
Martin
M
Sacher
Fréderic
F
Victor
Jacques
J
Clémenty
Jacques
J
Haïssaguerre
Michel
M
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*