Transient left ventricular dysfunction during fever-induced Brugada-like electrocardiographic pattern

After a fall at home that was preceded by lightheadedness, a 55-year-old male was admitted to the neurosurgery department with a minor head injury. There were no neurological deficits, and head multislice computed tomography revealed no structural abnormalities. On the fourth hospital day, the patient developed a fever (39.1°C) associated with chest pain and dyspnoea. The 12-lead electrocardiogram (ECG) showed the right bundle branch block (RBBB) and ST-segment elevation (STE) in the right precordial leads (coved in V1 and saddleback shaped in V2) consistent with Brugada ECG pattern (Figure A). Standard and speckle tracking echocardiography showed hypokinesia of the distal anterior and posterolateral walls (Figure A). Cardiac troponin I was mildly elevated (1.46 ng/mL; normal range <0.5 ng/mL) while coronary angiography revealed normal coronary arteries. Six days later, the fever waned in parallel with both ECG and echocardiographic changes. There were neither RBBB nor STE noted on discharge ECG (Figure B). Given a high clinical index of suspicion of an arrhythmic event leading to the head injury, the patient underwent an early post-discharge ajmaline challenge. The test was positive and an implantable cardioverter-defibrillator was inserted. Our report suggests that fever-induced Brugada ECG pattern may be associated with transient left ventricular systolic dysfunction. The full-length version of this report can be viewed at: http://www.escardio.org/Guidelines-&-Education/E-learning/Clinical-cases/Electrophysiology/EP-Case-Reports.