Fever of Unknown Origin Triggered Ventricular Fibrillation in a Patient with Brugada Syndrome Characterized by a Marked Conduction Disturbance

Abstract

We present the case of a 71-year-old male patient who was admitted to our hospital for fever and implantable cardioverter defibrillator (ICD) shocks for ventricular fibrillation (VF) . He has a strong family history of sudden death. He had a history of syncope at age 54. He suffered cardiopulmonary arrest at age 64, and survived by the cardio-pulmonary resuscitation. ECG showed complete right bundle branch block (QRS duration : 170msec, notch in precordial leads V₁-V₂) . Single-averaged ECG revealed a positive result. Investigations such as echocardiography, myocardial scintigraphy, cardiac magnetic resonance imaging, coronary angiography, myocardial biopsy did not reveal any significant cardiac abnormalities. Coved type ST-T elevation was observed by the pilsicainide challenge test. We considered the possibility of the Brugada syndrome or the early stage of the arrhythmogenic right ventricular cardiomyopathy, and implanted an ICD at that time. His condition has been stable for six years after the ICD implantation. During this hospitalization, however, it was difficult to control VF, because the VF was triggered by a fever of unknown origin. This patient case may be helpful to learn the differential diagnosis of the primary disease of VF and how to deal with VF triggered by fever.