Recurrent ventricular fibrillation during a febrile illness in a patient with the Brugada syndrome

Different situations have been involved in the origin of ventricular arrhyt hmic events in patients with the Brugada syndrome such as bradycardia, alco hol consumption and mental stress. We present a 30 year old male with recur rent ventricular fibrillation due to a febrile illness with intense sweatin g. He had been previously studied at our Unit in 1995 because of an episode of resuscitated cardiac arrest due to ventricular fibrillation. The twelve -lead electrocardiogram showed the typical characteristics of a patient wit h the Brugada syndrome. Different invasive and non-invasive tests performed were normal. He received a defibrillator and had no recurrences during 4 y ears of follow up. In March, 1999, after an upper respiratory tract infecti on he had high fever treated with paracetamol but at down he had sweating a nd chills, followed by 3 defibrillator shocks. Late interrogation showed 5 episodes of ventricular fibrillation, two of them non-sustained, and the re st adequately treated by the defibrillator. Activation and inactivation kin etics for early INa are twofold faster at higher temperature, and shift act ivation and steady-state inactivation. This may explain the role of the tem perature as a trigger for ventricular arrhythmias in our patient.