Fever-Related Ventricular Fibrillation　― Potential Adverse Effect of SARS-CoV-2 Vaccination in Patients With Brugada Syndrome ―

A 41-year-old man with a history of Brugada syndrome (BrS) implanted with a subcutaneous implantable cardioverter defibrillator (S-ICD) for ventricular fibrillation (VF) 1 year before, was followed and experienced no arrhythmic events (AEs) (Figure A). The patient was inoculated with the first-dose of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination (COVID-19 vaccination) (Comirnaty, BioNTech/Pfizer) 3 weeks before, and no side-effects including a febrile event were observed. He underwent the second-dose of the SARS-CoV-2 vaccination and experienced feverish development. The S-ICD appropriately worked twice for VF events at 30 h post-second dose of the SARS-CoV-2 vaccination. On arrival to the emergency department, he had slight fever and an electrocardiogram (ECG) showed significant increasing ST-segment elevation in V1–V3 leads compared with those on a previous ECG (Figure B,C). Anti-arrhythmic medications, including isoproterenol and quinidine, and an antipyretic (acetaminophen) were administered, and his body temperature decreased and the newly developed ST-elevation resolved (Figure D,E).

Figure.

Electrocardiogram at (A) baseline, (B) when the patient experiences a febrile condition (arrows indicate ST-elevation), and (E) at discharge. (C) Electrocardiogram records stored in an implantable cardioverter defibrillator. (D) Time course post-second-dose of the SARS-CoV-2 vaccination. VF, ventricular fibrillation.

SARS-CoV-2 vaccination is reportedly effective to prevent SARS-CoV-2 infection or reduce the severity of SARS-CoV-2 infection. Adverse reactions of pyrexia are more frequently observed with the second-dose of the SARS-CoV-2 vaccination.¹ BrS patients have an increased risk of fever-related AEs.² Therefore, prophylaxis with an antipyretic pre-SARS-CoV-2 vaccination is suggested for BrS patients in Europe.³ In this case study, the patient had a febrile reaction to the second-dose of the SARS-CoV-2 vaccination, which potentially lead to VF. This report supports the recommendation that BrS patients should take antipyretics pre-SARS-CoV-2 vaccination for preventing these SARS-CoV-2 vaccination-related catastrophic AEs. Furthermore, careful management of a febrile adverse reaction should be performed, particularly in BrS patients without an ICD.

Acknowledgments

None.

Disclosures

The authors declare no conflicts of interest.

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