Fever secondary to aspiration pneumonia can unmask a type 2 Brugada pattern, prompting an ajmaline challenge test to confirm type 1 Brugada syndrome and subsequent ICD placement to prevent sudden cardiac arrest.
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Fever may unmask Brugada patterns warranting evaluation; this case report leaves open broader screening or ICD protocols.
Brugada syndrome (BrS) is a rare autosomal dominant mutation affecting sodium channels. Electrocardiography can show two Brugada patterns (BrP). Type 1 BrP usually causes sudden cardiac arrest (SCA). Type 2 BrP can appear during circumstances that result in delayed sodium channel opening, such as fever, pneumonia, or use of sodium channel blockers. Patients with type 2 BrP often have underlying type 1 BrP; this can be confirmed by an ajmaline challenge test. We describe the case of a patient who presented with SCA. He later had an interval type 2 BrP secondary to aspiration pneumonia, followed by type 1 BrP pattern confirmed by an ajmaline challenge test. The patient ultimately underwent implantable cardiac defibrillator placement to prevent future SCA.
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Sattar et al. (2020) studied this question.
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