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Dendramis G, Brugada P. Ventricular arrhythmias related to COVID-19 infection and vaccination in patients with Brugada syndrome: The importance of a correct patient stratification. J Cardiovasc Electrophysiol 2023; 34:1508-1509. [PMID: 37265020 DOI: 10.1111/jce.15959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 05/21/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Gregory Dendramis
- Department of Cardiovascular, Clinical and Interventional Arrhythmology, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo, Italy
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
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Kreinbrook JA, Foster A, Paulino L, Leonelli F. Ventricular Fibrillation in an Afebrile COVID-19 Patient Presenting With Transient Type-I Brugada Pattern. Cureus 2023; 15:e38220. [PMID: 37252507 PMCID: PMC10224782 DOI: 10.7759/cureus.38220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
COVID-19 has been associated with an increased risk of both atrial and ventricular arrhythmias. Brugada syndrome (BrS), an inherited sodium channelopathy presenting with a characteristic ECG morphology, confers a baseline risk of ventricular arrhythmias such as ventricular fibrillation (VF), especially during febrile illnesses. However, mimics of BrS, termed Brugada phenocopies (BrP), have been noted in association with fever, electrolyte abnormalities, and toxidromes outside of viral illness. Such presentations manifest the same ECG pattern, the type-I Brugada pattern (type-I BP). Thus, the acute stage of an illness such as COVID-19, when accompanied by a first-time presentation of type-I BP, may not result in a certain diagnosis of BrS versus BrP. Thus, expert recommendations are to anticipate arrhythmia regardless of the presumed diagnosis. Here we demonstrate the importance of these guidelines and a novel report of VF in the setting of a transient type-I BP in afebrile COVID-19. We discuss the potential factors which may have triggered VF, the presentation of isolated "coved" ST elevation in V1, and the difficulty of BrS versus BrP diagnosis in acute illness. In summary, a SARS-CoV-2 positive 65-year-old male without significant cardiac history for BrS presented with type-I BP after two days of shortness of breath. Hypoxemia, hyperkalemia, hyperglycemia, elevated inflammatory markers, and acute kidney injury were present. After treatment, his ECG normalized; however, aborted VF occurred days later while afebrile and normokalemic. Follow-up ECG again revealed a type-I BP, which also became more apparent during an episode of bradycardia, a classic finding in BrS. This case suggests that there is room for larger studies to determine the prevalence and outcomes when type-I BP presents in acute COVID-19. When possible, genetic data should be obtained to confirm BrS, a notable limitation in our case. Regardless, it corroborates guideline-directed clinical management, with heightened vigilance for arrhythmia in such patients until full recovery.
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Affiliation(s)
| | - Annalia Foster
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, USA
| | - Luis Paulino
- Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Fabio Leonelli
- Cardiology, James A. Haley Veterans' Hospital, Tampa, USA
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Okuyama T, Kabutoya T, Gonda Y, Kubota Kashihara K, Imai Y, Morisawa Y, Kario K. Syncope after COVID-19 Vaccination in a Young Man with Unmasking Brugada Syndrome. Intern Med 2023; 62:1191-1194. [PMID: 36754404 PMCID: PMC10183274 DOI: 10.2169/internalmedicine.1250-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
A 23-year-old man with no significant medical history was rushed to a hospital due to transient loss of consciousness with incontinence. The patient had developed a fever after his second dose of COVID-19 vaccine, and the patient was found groaning in bed approximately 40 hours after the vaccination in the early morning. The patient was diagnosed with Brugada syndrome (BrS) based on a drug-provocation test. His father had been diagnosed with BrS and died suddenly at 51 years of age. Young adults with a family history of BrS should be cautioned about fever following COVID-19 vaccination.
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Affiliation(s)
- Takafumi Okuyama
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Tomoyuki Kabutoya
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Yuki Gonda
- Division of Cardiology, Mitsui Memorial Hospital, Japan
| | - Kana Kubota Kashihara
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Yasushi Imai
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Yuji Morisawa
- Division of Infectious Diseases, Jichi Medical University School of Medicine, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan
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Bergamo D, Nelson C. Brugada pattern in adolescent with acute myocarditis due to SARS‐CoV‐2. J Am Coll Emerg Physicians Open 2022; 3:e12810. [PMID: 36176505 PMCID: PMC9474391 DOI: 10.1002/emp2.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 12/03/2022] Open
Abstract
Brugada syndrome is a genetic disorder characterized by abnormal findings on electrocardiogram (ECG) that can precipitate ventricular tachyarrhythmias and sudden cardiac death. Most clinical manifestations of Brugada syndrome are related to life‐threatening tachyarrhythmias, such as ventricular fibrillation or polymorphic ventricular tachycardia, but Brugada syndrome can also present with syncope or less likely palpitations. Our case is of a previously healthy 17‐year‐old visiting from Puerto Rico who presented to the emergency department (ED) with a syncopal episode preceded by sore throat, dizziness, and lightheadedness without palpitations. The ED evaluation found a normal complete blood count and basic metabolic panel. The patient tested positive for COVID‐19 by polymerase chain reaction. An ECG was performed that showed the Brugada pattern, which was later confirmed by cardiology. Although Brugada syndrome and pattern are well known to the medical population, the findings of Brugada pattern in the setting of COVID‐19 is not well described. Recognition and treatment are important, as Brugada syndrome can lead to life‐threatening arrhythmias and sudden cardiac death.
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Affiliation(s)
- David Bergamo
- Department of Pediatric Emergency Medicine Nemours Children's Hospital Delaware Wilmington Delaware USA
| | - Courtney Nelson
- Department of Pediatric Emergency Medicine Nemours Children's Hospital Delaware Wilmington Delaware USA
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Singh AK. Recognition and Management Considerations of Cardiac Channelopathies in the Intensive Care Unit. Crit Care Clin 2022; 38:231-242. [DOI: 10.1016/j.ccc.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Zimmermann P, Aberer F, Braun M, Sourij H, Moser O. The Arrhythmogenic Face of COVID-19: Brugada ECG Pattern in SARS-CoV-2 Infection. J Cardiovasc Dev Dis 2022; 9:jcdd9040096. [PMID: 35448072 PMCID: PMC9027624 DOI: 10.3390/jcdd9040096] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 12/15/2022] Open
Abstract
In 1992, Brugada syndrome (BS) was first described; an often unrecognized cardiac conduction disorder mainly associated with unexplained sudden cardiac arrest and consecutive syncope. Nevertheless, the pathomechanism of BS and sudden cardiac death remains mainly explained. Mutations in the cardiac sodium channels, which cause a reduction or functional loss of these channels, are associated with characteristic electrocardiographic (ECG) abnormalities and malignant arrhythmia. The majority of affected people are previously healthy and unaware of their genetic predisposition for BS and might experience ventricular tachyarrhythmias and cardiac arrest potentially triggered by several factors (e.g., alcohol, sodium channel blockers, psychotropic drugs, and fever). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was firstly identified in Wuhan in early December 2019 and rapidly spread worldwide as coronavirus disease (COVID-19). COVID-19 is typically characterized by a severe inflammatory response, activation of the immune system, and high febrile illness. Due to this condition, symptomatic COVID-19 infection or vaccination might serve as inciting factor for unmasking the Brugada pattern and represents a risk factor for developing proarrhythmic complications. The aim of this narrative review was to detail the association between virus-related issues such as fever, electrolyte disturbance, and inflammatory stress of COVID-19 infection with transient Brugada-like symptoms and ECG-pattern and its susceptibility to proarrhythmogenic episodes.
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Affiliation(s)
- Paul Zimmermann
- Department of Sport Science, Division of Exercise Physiology and Metabolism, University of Bayreuth, 95447 Bayreuth, Germany; (P.Z.); (O.M.)
- Department of Cardiology, Klinikum Bamberg, 96049 Bamberg, Germany;
| | - Felix Aberer
- Department of Sport Science, Division of Exercise Physiology and Metabolism, University of Bayreuth, 95447 Bayreuth, Germany; (P.Z.); (O.M.)
- Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria;
- Correspondence: ; Tel.: +43-316-385-86113
| | - Martin Braun
- Department of Cardiology, Klinikum Bamberg, 96049 Bamberg, Germany;
| | - Harald Sourij
- Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria;
| | - Othmar Moser
- Department of Sport Science, Division of Exercise Physiology and Metabolism, University of Bayreuth, 95447 Bayreuth, Germany; (P.Z.); (O.M.)
- Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria;
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Jain A, Yagnik K, Hussain KM, Naik S, Sharma T, Shahab A, Khilan MH. Pyrexia Unmasking Brugada Syndrome: A Literature Review. Cureus 2022; 14:e22489. [PMID: 35371667 PMCID: PMC8942134 DOI: 10.7759/cureus.22489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 11/05/2022] Open
Abstract
Brugada syndrome (BrS) is an inherited arrhythmia syndrome in which asymptomatic patients tend to develop fatal arrhythmias leading to sudden cardiac death (SCD) in asymptomatic or undiagnosed cases. This review tries to shed light on pyrexia being one of the triggers to cause SCD secondary to fatal arrhythmias in patients of BrS. Pyrexia, electrolyte imbalance, alcohol intake, and drugs are common triggering factors for fatal arrhythmias in patients with BrS. Most patients are asymptomatic, while the most common form of presentation that brings the patient under medical attention is syncope or SCD. Hence, patients, especially young, who present with syncope or aborted episode of SCD with typical EKG patterns, should undergo further workup. It is essential to educate patients about the condition, possible triggers, and the importance of refraining them.
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Abstract
Coronavirus disease 2019 (COVID-19) has encompassed the globe since it was first observed just under 2 years ago. Although the disease is predominantly a respiratory illness, there have been observed complications throughout the various organ systems. Namely, cardiovascular complications, and, more specifically, arrhythmic complications have been described throughout the pandemic in patients with COVID-19. Management of atrial arrhythmias, ventricular arrhythmias, and bradyarrhythmias in patients with COVID-19 infection has been largely guided by our prior experience in the management of these arrhythmias in similar patient populations without infection. However, this review aims to highlight the specific considerations as they pertain to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the various arrhythmic manifestations observed with this disease.
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Affiliation(s)
| | | | - Elaine Y. Wan
- Address reprint requests and correspondence: Dr Elaine Wan, MD, FACC, FAHA, FHRS, Esther Aboodi Associate Professor of Medicine, 622 W 168th St, PH 3-Center, New York, NY 10032.
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Caturano A, Pafundi PC, Sasso FC, Dendramis G, Brugada P, Russo V. Brugada syndrome and COVID-19 vaccines. Europace 2021; 23:1871-1872. [PMID: 34383900 PMCID: PMC8385984 DOI: 10.1093/europace/euab211] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/16/2021] [Indexed: 01/25/2023] Open
Affiliation(s)
- Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, IT-80138 Naples, Italy
| | - Pia Clara Pafundi
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, IT-80138 Naples, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, IT-80138 Naples, Italy
| | - Gregory Dendramis
- Department of Cardiology, ARNAS Ospedale Civico e Benfratelli, Palermo, Italy.,Department of Cardiology, Heart Rhythm Managment Centre, UZ Brussel-VUB, Brussels, Belgium
| | - Pedro Brugada
- Department of Cardiology, Heart Rhythm Managment Centre, UZ Brussel-VUB, Brussels, Belgium
| | - Vincenzo Russo
- Division of Cardiology, Department of Medical Translational Sciences, Monaldi Hospital, University of Campania "Luigi Vanvitelli" Naples, Italy
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