Fever and other precipitants of ventricular arrhythmias in Brugada syndrome versus other known arrhythmic syndromes

Fever and other precipitating factors for ventricular arrhythmias induction have been reported in the literature for Brugada syndrome. Vagal manovroues, vagal stimuli and bradycardia itself could be TF of serious events, differently from other arrhythmic syndromes, in all of which the sympathetic tone alone or in combination with other factors, is considered the most important triggering factor of AE. Hypokalemia between other electrolytic disorders and use of certain drugs should be carefully controlled. Stress test in not useful in Brugada syndrome, unless for some arrhythmias occuring in the post exercise and recovery phases, when the vagal tone is predominant. Sport activity is not allowed in clearly diagnosed Brugada syndrome subjects or drug induced abnormalities after provocative test even in asymptomatic subjects. Conversely, stress test, and provocative manouvers are particularly useful and, sometimes even more useful than PES, in the so called cathecolaminergic precipitated ventricular arrhythmias. Patients presen ting with syncope and a spontaneously appearing type 1 ECG, have a recurrence rate of 19% at 26±36 months of follow-up in our experience. An 8% occurrence of cardiac events was observed in initially asymptomatic patients. A comparison of the most selected patient populations of Brugada syndrome is reported, comparing data from Priori's, Eckardt's and Corrado's series. Our data are more similar to the Brugada's data, having probably followed-up a more selected population, including many families, with a striking evidence of cardiac arrest and early occurring in life SCD. Conversely and similarly, among asymptomatic patients, those at the highest risk, seem to be the ones with a type 1 ECG spontaneously, those with syncope, those with the coved type versus the saddle back type and those with the presence of a history of cardiac arrest in the family.