A young F is hyperthermic, delirious, and dry: Fever-induced Brugada? Diphenhydramine toxicity? Tricyclic?

Conclusion of this paper: Fever is a great risk factor for arrhythmia events in Brugada Syndrome patients. Patients with known fever-triggered Brugada syndrome should be surveilled closely during fever and be started on antipyretic therapy as soon as possible.  There are limited data regarding the impact of EP study in BrS patients triggered by fever.  An EP study might be helpful in symptomatic patients (Sroubek et al., 2016) in the presence of spontaneous BrS ECG or drug-induced ECG.The prognostic significance of fever-induced Brugada syndrome.  Heart Rhythm 2016.Eighty-eight asymptomatic patients with fever induced Type 1 Brugada syndrome 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).Fever-related arrhythmic events in the multicenter Survey on Arrhythmic Events in Brugada Syndrome.  Heart Rhythm 2018.  In 588 patients with known Brugada syndrome andfirst arrhythmic event, 35 were during fever.  Family history of sudden death,  history of syncope, and spontaneous type 1 Brugada ECG were noted in 17%, 40%, and 71% of patients, respectively. VF was induced at EP study in 9 of 19 pati...
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