Appropriate implantable cardioverter-defibrillator therapy triggered by heat stroke

We present a case of a 20 years old male with a history of syncope and Brugada type 1 pattern confirmed by a pharmacological test with flecainide, inducible ventricular tachycardia on an electrophysiological study, and had undergone placement of implantable cardioverter-defibrillator (ICD). In 12 months of follow-up, the patient was asymptomatic; on a day of extreme heat (46°C), he had a presyncope episode followed by an ICD shock. The patient was brought to the emergency room with heat stroke symptoms. ECG showed a Brugada type 1 pattern, and ICD interrogation showed ventricular fibrillation followed by successful conversion with 36-joules shock. Physical methods were used to lower body temperature in addition to intravenous fluids infusion. The patient was stabilized and discharged after 48 hrs.