Fever Following Covid-19 Vaccination in Subjects with Brugada Syndrome: Incidence and Management

Overview

Journal J Cardiovasc Electrophysiol

Specialties Cardiology & Vascular Diseases
Physiology

Date 2022 Jun 13

PMID 35695789

Authors

Francesco Santoro

Pasquale Crea

Pier Luigi Pellegrino

Rosa Cetera

Domenico Gianfrancesco

Mohammad Abumayyaleh

Dattilo Giuseppe

Marta Allegra

Nastasia Mancini

Girolamo DArienzo

Andreas Mgge

Assem Aweimer

Francesco Bartolomucci

Ibrahim Akin

Ibrahim El-Battrawy

Natale Daniele Brunetti

Affiliations

Soon will be listed here.

Abstract

Background: Fever is a potential side effect of the Covid-19 vaccination. Patients with Brugada syndrome (BrS) have an increased risk of life-threatening arrhythmias when experiencing fever. Prompt treatment with antipyretic drugs is suggested in these patients.

Aim Of The Study: To evaluate the incidence and management of fever within 48 h from Covid-19 vaccination among BrS patients.

Methods: One hundred sixty-three consecutive patients were enrolled in a prospective registry involving five European hospitals with a dedicated inherited disease ambulatory.

Results: The mean age was 50 ± 14 years and 121 (75%) patients were male. Prevalence of Brugada electrocardiogram (ECG) pattern type-1, -2, and -3 was 32%, 44%, and 24%, respectively. Twenty-eight (17%) patients had an implantable cardioverter-defibrillator (ICD). Fever occurred in 32 (19%) BrS patients after 16 ± 10 h from vaccination, with a peak of body temperature of 37.9° ± 0.5°. Patients with fever were younger (39 ± 13 vs. 48 ± 13 years, p = .04). No additional differences in terms of sex and cardiovascular risk factors were found between patients with fever and not. Twenty-seven (84%) out of 32 patients experienced mild fever and five (16%) moderate fever. Pharmacological treatment with antipyretic drugs was required in 18 (56%) out of 32 patients and was associated with the resolution of symptoms. No patient required hospital admission and no arrhythmic episode was recorded in patients with ICD within 48 h after vaccination. No induced type 1 BrS ECG pattern and new ECG features were found among patients with moderate fever.

Conclusion: Fever is a common side effect in BrS patients after the Covid-19 vaccination. Careful evaluation of body temperature and prompt treatment with antipyretic drugs may be needed.

Citing Articles

Can Hyperthermia Unveil Brugada Pattern?.

Vinod P, Patel H J Med Cases. 2024; 15(7):143-147.

PMID: 38993811 PMC: 11236330. DOI: 10.14740/jmc4242.

Cardiac Arrhythmias in Post-COVID Syndrome: Prevalence, Pathology, Diagnosis, and Treatment.

Huseynov A, Akin I, Duerschmied D, Scharf R Viruses. 2023; 15(2).

PMID: 36851603 PMC: 9959721. DOI: 10.3390/v15020389.

Management of hemodynamically stable wide QRS complex tachycardia in patients with implantable cardioverter defibrillators.

Regoli F, Cattaneo M, Kola F, Thartori A, Bytyci H, Saccarello L Front Cardiovasc Med. 2023; 9:1011619.

PMID: 36684577 PMC: 9846131. DOI: 10.3389/fcvm.2022.1011619.

Reply to fever, Covid-19 vaccination, and Brugada syndrome-Incidence and management: Correspondence.

Santoro F, Crea P, El-Battrawy I, Brunetti N J Cardiovasc Electrophysiol. 2022; 33(9):2122.

PMID: 35924484 PMC: 9538316. DOI: 10.1111/jce.15638.

Fever, COVID-19 vaccination, and Brugada syndrome: Incidence and management-Correspondence.

Sookaromdee P, Wiwanitkit V J Cardiovasc Electrophysiol. 2022; 33(9):2121.

PMID: 35924467 PMC: 9539248. DOI: 10.1111/jce.15636.

References

El-Battrawy I, Albers S, Cyganek L, Zhao Z, Lan H, Li X . A cellular model of Brugada syndrome with SCN10A variants using human-induced pluripotent stem cell-derived cardiomyocytes. Europace. 2019; 21(9):1410-1421. DOI: 10.1093/europace/euz122. View

Menni C, Klaser K, May A, Polidori L, Capdevila J, Louca P . Vaccine side-effects and SARS-CoV-2 infection after vaccination in users of the COVID Symptom Study app in the UK: a prospective observational study. Lancet Infect Dis. 2021; 21(7):939-949. PMC: 8078878. DOI: 10.1016/S1473-3099(21)00224-3. View

El-Battrawy I, Lang S, Zhao Z, Akin I, Yucel G, Meister S . Hyperthermia Influences the Effects of Sodium Channel Blocking Drugs in Human-Induced Pluripotent Stem Cell-Derived Cardiomyocytes. PLoS One. 2016; 11(11):e0166143. PMC: 5102382. DOI: 10.1371/journal.pone.0166143. View

Sadoff J, Gray G, Vandebosch A, Cardenas V, Shukarev G, Grinsztejn B . Safety and Efficacy of Single-Dose Ad26.COV2.S Vaccine against Covid-19. N Engl J Med. 2021; 384(23):2187-2201. PMC: 8220996. DOI: 10.1056/NEJMoa2101544. View

Amin A, Meregalli P, Bardai A, Wilde A, Tan H . Fever increases the risk for cardiac arrest in the Brugada syndrome. Ann Intern Med. 2008; 149(3):216-8. DOI: 10.7326/0003-4819-149-3-200808050-00020. View

Mizusawa Y, Morita H, Adler A, Havakuk O, Thollet A, Maury P . Prognostic significance of fever-induced Brugada syndrome. Heart Rhythm. 2016; 13(7):1515-20. DOI: 10.1016/j.hrthm.2016.03.044. View

Ogoina D . Fever, fever patterns and diseases called 'fever'--a review. J Infect Public Health. 2011; 4(3):108-24. DOI: 10.1016/j.jiph.2011.05.002. View

Schmidt C, Wiedmann F, El-Battrawy I, Fritz M, Ratte A, Beller C . Reduced Na Current in Native Cardiomyocytes of a Brugada Syndrome Patient Associated With β-2-Syntrophin Mutation. Circ Genom Precis Med. 2018; 11(11):e002263. DOI: 10.1161/CIRCGEN.118.002263. View

Garcia-Elias A, Benito B . Ion Channel Disorders and Sudden Cardiac Death. Int J Mol Sci. 2018; 19(3). PMC: 5877553. DOI: 10.3390/ijms19030692. View

10.

Roterberg G, El-Battrawy I, Veith M, Liebe V, Ansari U, Lang S . Arrhythmic events in Brugada syndrome patients induced by fever. Ann Noninvasive Electrocardiol. 2019; 25(3):e12723. PMC: 7358877. DOI: 10.1111/anec.12723. View

11.

Nademanee K, Raju H, de Noronha S, Papadakis M, Robinson L, Rothery S . Fibrosis, Connexin-43, and Conduction Abnormalities in the Brugada Syndrome. J Am Coll Cardiol. 2015; 66(18):1976-1986. PMC: 4631798. DOI: 10.1016/j.jacc.2015.08.862. View

12.

Santoro F, Crea P, Pellegrino P, Cetera R, Gianfrancesco D, Abumayyaleh M . Fever following Covid-19 vaccination in subjects with Brugada syndrome: Incidence and management. J Cardiovasc Electrophysiol. 2022; 33(8):1874-1879. PMC: 9350146. DOI: 10.1111/jce.15596. View

13.

Postema P, Wolpert C, Amin A, Probst V, Borggrefe M, Roden D . Drugs and Brugada syndrome patients: review of the literature, recommendations, and an up-to-date website (www.brugadadrugs.org). Heart Rhythm. 2009; 6(9):1335-41. PMC: 2779019. DOI: 10.1016/j.hrthm.2009.07.002. View

14.

El-Battrawy I, Lang S, Zhou X, Akin I . Different genotypes of Brugada syndrome may present different clinical phenotypes: electrophysiology from bench to bedside. Eur Heart J. 2021; 42(13):1270-1272. DOI: 10.1093/eurheartj/ehab070. View

15.

El-Battrawy I, Muller J, Zhao Z, Cyganek L, Zhong R, Zhang F . Studying Brugada Syndrome With an SCN1B Variants in Human-Induced Pluripotent Stem Cell-Derived Cardiomyocytes. Front Cell Dev Biol. 2019; 7:261. PMC: 6839339. DOI: 10.3389/fcell.2019.00261. View

16.

Polack F, Thomas S, Kitchin N, Absalon J, Gurtman A, Lockhart S . Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020; 383(27):2603-2615. PMC: 7745181. DOI: 10.1056/NEJMoa2034577. View

17.

Antzelevitch C, Patocskai B . Brugada Syndrome: Clinical, Genetic, Molecular, Cellular, and Ionic Aspects. Curr Probl Cardiol. 2015; 41(1):7-57. PMC: 4737702. DOI: 10.1016/j.cpcardiol.2015.06.002. View

18.

Priori S, Wilde A, Horie M, Cho Y, Behr E, Berul C . HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes: document endorsed by HRS, EHRA, and APHRS in May 2013 and by ACCF, AHA, PACES, and AEPC in June 2013. Heart Rhythm. 2013; 10(12):1932-63. DOI: 10.1016/j.hrthm.2013.05.014. View

19.

Kokawa T, Yamamoto H, Itoh M, Shimane A, Kawai H, Takaya T . Fever-Related Ventricular Fibrillation　- Potential Adverse Effect of SARS-CoV-2 Vaccination in Patients With Brugada Syndrome. Circ J. 2021; 86(3):474. DOI: 10.1253/circj.CJ-21-0750. View

20.

Wilde A, Antzelevitch C, Borggrefe M, Brugada J, Brugada R, Brugada P . Proposed diagnostic criteria for the Brugada syndrome: consensus report. Circulation. 2002; 106(19):2514-9. DOI: 10.1161/01.cir.0000034169.45752.4a. View