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Fever Risk in Brugada — EECC MCQ

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ModerateGeneral CardiologyFever Risk in BrugadaEECC

A 50-year-old man with known Brugada syndrome develops fever (39.5°C) from a urinary tract infection. His ECG now shows a spontaneous type 1 Brugada pattern (previously only drug-induced). Why is fever dangerous in Brugada syndrome and what is the management?

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Correct answer: D — Fever unmasks the Brugada ECG pattern and increases arrhythmic risk by further impairing sodium channel function (which is already genetically deficient); aggressive antipyretic therapy (paracetamol, ibuprofen, physical cooling) is essential and hospitalisation for continuous monitoring should be considered

In Brugada syndrome, the cardiac sodium channels (typically SCN5A mutations) have temperature-sensitive kinetics. Fever accelerates sodium channel inactivation, further reducing the already impaired INa, unmasking or worsening the type 1 ECG pattern and increasing the risk of VF. Multiple case reports and series document cardiac arrest triggered by fever in Brugada patients. The ESC 2022 VA/SCD Guidelines recommend: (1) ALL Brugada patients should be counselled about fever risk; (2) aggressive antipyretic therapy for any fever (paracetamol, NSAIDs, physical cooling measures); (3) seek medical attention promptly; (4) hospitalisation with continuous monitoring should be considered for fever ≥38.5°C; (5) ensure the fever is not caused by a sodium channel-blocking drug. This applies to ALL Brugada patients, regardless of whether they have an ICD.

Reference: ESC (2022): VA/SCD Guidelines