title: Prognostic significance of fever-induced Brugada syndrome.
abstract: In Brugada syndrome (BrS), spontaneous type 1 electrocardiogram (ECG) is an established risk marker for fatal arrhythmias whereas drug-induced type 1 ECG shows a relatively benign prognosis. No study has analyzed the prognosis of fever-induced type 1 ECG (F-type1) in a large BrS cohort.
  
  
  
  The objectives of this study were to assess the prognosis of F-type1 in asymptomatic BrS and to compare the effects of fever and drugs on ECG parameters.
  
  
  
  One hundred twelve patients with BrS who developed F-type1 were retrospectively enrolled. Prognosis was evaluated in 88 asymptomatic patients. In a subgroup (n = 52), ECG parameters of multiple ECGs (at baseline, during fever, and after drug challenge) were analyzed.
  
  
  
  Eighty-eight asymptomatic patients had a mean age of 45.8 ± 18.7 years, and 71.6% (67 of 88) were men. Twenty-one percent (18 of 88) had a family history of sudden cardiac death, and 26.4% (14 of 53) carried a pathogenic SCN5A mutation. Drug challenge was positive in 29 of 36 patients tested (80.6%). The risk of ventricular fibrillation in asymptomatic patients was 0.9%/y (3 of 88; 43.6 ± 37.4 months). ST-segment elevation in lead V2 during fever and after drug challenge was not significantly different (0.41 ± 0.21 ms during fever and 0.40 ± 0.30 ms after drug challenge; P > .05). Fever shortened the PR interval compared to baseline, whereas drug challenge resulted in prolonged PR interval and QRS duration (PR interval: 169 ± 29 ms at baseline, 148 ± 45 ms during fever, and 202 ± 35 ms after drug challenge; QRS duration: 97 ± 18 ms at baseline, 92 ± 28 ms during fever, and 117 ± 21 ms after drug challenge).
  
  
  
  Patients with BrS who develop F-type1 are at risk of arrhythmic events. F-type1 appears to develop through a more complex mechanism as compared with drug-induced type 1 ECG.
authors.affiliation: Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Mizusawa
authors.affiliation: Department of Cardiovascular Medicine, Okayama University of Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Morita
authors.affiliation: Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Arnon
authors.initials: A
authors.lastname: Adler
authors.affiliation: Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Ofer
authors.initials: O
authors.lastname: Havakuk
authors.affiliation: INSERM, UMR 1087, Institut du thorax, Université de Nantes, Nantes, France; CNRS, UMR 6291, Institut du thorax, Université de Nantes, Nantes, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Thollet
authors.affiliation: University Hospital Rangueil, Toulouse, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Maury
authors.affiliation: Department of Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Dao W
authors.initials: DW
authors.lastname: Wang
authors.affiliation: Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China.
authors.forename: Kui
authors.initials: K
authors.lastname: Hong
authors.affiliation: UPMC, University Paris 6, INSERM, UMRS 956, Institut de Cardiologie (AP-HP), Paris, France; AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.
authors.forename: Estelle
authors.initials: E
authors.lastname: Gandjbakhch
authors.affiliation: Bordeaux University Hospital, IHU Institut de Rythmologie et Modélisation Cardiaque, Inserm U1045, Université de Bordeaux, Bordeaux, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Sacher
authors.affiliation: Masonic Medical Rearch Laboratory, Utica, New York.
authors.forename: Dan
authors.initials: D
authors.lastname: Hu
authors.affiliation: Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Ahmad S
authors.initials: AS
authors.lastname: Amin
authors.affiliation: Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Najim
authors.initials: N
authors.lastname: Lahrouchi
authors.affiliation: Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Hanno L
authors.initials: HL
authors.lastname: Tan
authors.affiliation: Lankenau Institute for Medical Research, Wynnewood, Pennsylvania.
authors.forename: Charles
authors.initials: C
authors.lastname: Antzelevitch
authors.affiliation: INSERM, UMR 1087, Institut du thorax, Université de Nantes, Nantes, France; CNRS, UMR 6291, Institut du thorax, Université de Nantes, Nantes, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Probst
authors.affiliation: Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Sami
authors.initials: S
authors.lastname: Viskin
authors.affiliation: Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. Electronic address: a.a.wilde@amc.uva.nl.
authors.forename: Arthur A M
authors.initials: AA
authors.lastname: Wilde
mesh_terms: D000328:Adult; D058070:Asymptomatic Diseases; D053840:Brugada Syndrome / Q000175:diagnosis / Q000503:physiopathology; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005334:Fever / Q000150:complications*; D006329:Heart Conduction System / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D026941:Sodium Channel Blockers / Q000009:adverse effects*; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology
chemical_list: D026941:Sodium Channel Blockers
keywords: Brugada syndrome; Drug-induced type 1 ECG; Fever-induced type 1 ECG; Prognosis