Background: Hot-bath related sudden death is sometimes observed and it is well known that fever aggravates ventricular arrhythmias in Brugada syndrome. Accordingly we examined the ECG changes during Hot-bath to identify high risk Brugada patients.
Methods: Total 31 Brugada patients [clinically documented ventricular fibrillation (VF) in 12] were examined. Waterproof Holter-ECGs (modified-NASA: the point at a maximum ST-elevation) during Hot-bath were recorded and compared with ECGs during sodium channel blocker (pilsicainide) administration. We also compared ECG changes with the clinical characteristics (SCN5A mutation, family history of sudden death and syncopal episode).
Results: Taking Hot-bath rose body temperature from 36.4±0.4°C to 38.1±1.8°C and increased ST-level significantly (0.17±0.15 to 0.31±0.25mV, P=0.0001). One patient developed VF (figure) during Hot-bath in whom ST-level was more elevated than that during pilsicainide administration. In accordance with ST-level change during Hot-bath and pilsicainide administration, we divided into two groups. Group 1 (n=11): ST-level was more elevated during Hot-bath than pilsicainide administration, and Group 2 (n=20): ST-level was less elevated during Hot-bath than pilsicainide administration. Family history of sudden death was more observed in Group1 (46%) than Group 2 (10%, P=0.02), but other parameters were not different between the groups.
Conclusion: Hot-bath aggravates ST-elevation in Brugada patients. Hot-Bath test would be useful to identify high risk Brugada patients.
Incidence of patients at high risk of sudden death among patients referred for the suspicion of a brugada-syndrome: a prospective study in 35 consecutive patients with Brugada-like ECG changes
