Ventricular Fibrillation in an Afebrile COVID-19 Patient Presenting With Transient Type-I Brugada Pattern

Area of Science:

• Cardiology
• Infectious Diseases
• Genetics

Background:

• COVID-19 increases arrhythmia risk, including atrial and ventricular arrhythmias.
• Brugada syndrome (BrS) presents a baseline risk for ventricular arrhythmias (VF), particularly during febrile illnesses.
• Brugada phenocopies (BrP) mimic BrS ECG patterns and can be triggered by various conditions, including infections.

Observation:

• A SARS-CoV-2 positive patient presented with type-I Brugada pattern (BP) during acute illness.
• The patient experienced hypoxemia, electrolyte abnormalities, and acute kidney injury.
• Ventricular fibrillation (VF) occurred days later in an afebrile state, despite normalized ECG and electrolytes.

Findings:

• The case demonstrates transient type-I BP in afebrile COVID-19, leading to VF.
• Distinguishing BrS from BrP in acute illness is challenging due to similar ECG presentations.
• ECG normalized post-treatment, but type-I BP recurred, exacerbated by bradycardia.

Implications:

• This case underscores the importance of guideline-directed management and vigilance for arrhythmias in COVID-19 patients with type-I BP.
• Further research is needed to determine the prevalence and outcomes of type-I BP in COVID-19.
• Genetic testing is recommended for definitive BrS diagnosis when possible.