Yonsei Med J.  2011 Nov;52(6):1025-1027. 10.3349/ymj.2011.52.6.1025.

Fever-Induced QTc Prolongation and Ventricular Fibrillation in a Healthy Young Man

• Lim SM
• Pak HN
• Lee MH
• Kim SS
• Joung B

• KMID: 1058826
• DOI: http://doi.org/10.3349/ymj.2011.52.6.1025

Abstract

Long QT syndrome is associated with lethal tachyarrhythmia that can lead to syncope, seizure, and sudden death. Congenital long QT syndrome is a genetic disorder, characterized by delayed cardiac repolarization and prolongation of the QT interval on the electrocardiogram (ECG). Type 2 congenital long QT is linked to mutations in the human ether a go-go-related gene (HERG). There are environmental triggers of adverse cardiac events such as emotional and acoustic stimuli, but fever can also be a potential trigger of life-threatening arrhythmias in long QT syndrome type 2 patients. Herein, we report a healthy young man who experienced fever-induced polymorphic ventricular tachycardia and QT interval prolongation.

Keyword

Sudden cardiac death; long QT syndrome; fever

MeSH Terms

Adult
Electrocardiography
Fever/*complications
Humans
Long QT Syndrome/*diagnosis/*etiology
Male
Ventricular Fibrillation/*diagnosis/*etiology

Figure

• 

  Fig. 1 (A) ECG taken on the 8th hospital day. QT and QTc intervals were 350 and 440 ms, respectively. (B) ECG taken on the 9th hospital day showing spontaneous onset of polymorphic ventricular tachycardia by the short-long-short sequences. Arrows indicate the premature ventricular contractions. QT and QTc intervals were 350 and 450 ms, respectively. ECG, electrocardiogram.

• 

  Fig. 2 ECG taken on the 28th hospital day. The patient had a fever of 38.5℃ and sinus tachycardia of 135 bpm. QT and QTc intervals were 365 and 535 ms, respectively. Note severe QT prolongation and U-wave in the leads of V5 and V6 (arrows). ECG, electrocardiogram.

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  Fig. 3 ECG during epinephrine (0.1 µg/kg/min) infusion. QT and QTc intervals of 430 and 515 ms, respectively. Note U-wave in the leads of V2 and V3 (arrows). ECG, electrocardiogram.

Reference

1. Burashnikov A, Shimizu W, Antzelevitch C. Fever accentuates transmural dispersion of repolarization and facilitates development of early afterdepolarizations and torsade de pointes under long-QT Conditions. Circ Arrhythm Electrophysiol. 2008. 1:202–208.

2. Pasquié JL, Sanders P, Hocini M, Hsu LF, Scavée C, Jais P, et al. Fever as a precipitant of idiopathic ventricular fibrillation in patients with normal hearts. J Cardiovasc Electrophysiol. 2004. 15:1271–1276.

3. Guo J, Zhan S, Lees-Miller JP, Teng G, Duff HJ. Exaggerated block of hERG (KCNH2) and prolongation of action potential duration by erythromycin at temperatures between 37 degrees C and 42 degrees C. Heart Rhythm. 2005. 2:860–866.

4. Schwartz PJ, Priori SG, Spazzolini C, Moss AJ, Vincent GM, Napolitano C, et al. Genotype-phenotype correlation in the long-QT syndrome: gene-specific triggers for life-threatening arrhythmias. Circulation. 2001. 103:89–95.

5. Lee SY, Kim JB, Im E, Yang WI, Joung B, Lee MH, et al. A case of catecholaminergic polymorphic ventricular tachycardia. Yonsei Med J. 2009. 50:448–451.

6. Mackowiak PA. Concepts of fever. Arch Intern Med. 1998. 158:1870–1881.

7. Amin AS, Herfst LJ, Delisle BP, Klemens CA, Rook MB, Bezzina CR, et al. Fever-induced QTc prolongation and ventricular arrhythmias in individuals with type 2 congenital long QT syndrome. J Clin Invest. 2008. 118:2552–2561.

8. Tester DJ, Will ML, Haglund CM, Ackerman MJ. Effect of clinical phenotype on yield of long QT syndrome genetic testing. J Am Coll Cardiol. 2006. 47:764–768.

9. MacRae CA. Closer look at genetic testing in long-QT syndrome: will DNA diagnostics ever be enough? Circulation. 2009. 120:1745–1748.

10. Roden DM. Long QT syndrome. N Engl J Med. 2008. 358:169–176.

11. Zhang L, Timothy KW, Vincent GM, Lehmann MH, Fox J, Giuli LC, et al. Spectrum of ST-T-wave patterns and repolarization parameters in congenital long-QT syndrome: ECG findings identify genotypes. Circulation. 2000. 102:2849–2855.

12. Kaufman ES. Mechanisms and clinical management of inherited channelopathies: long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, and short QT syndrome. Heart Rhythm. 2009. 6:S51–S55.

13. Saura D, García-Alberola A, Carrillo P, Pascual D, Martínez-Sánchez J, Valdés M. Brugada-like electrocardiographic pattern induced by fever. Pacing Clin Electrophysiol. 2002. 25:856–859.

14. Park SR, Kwak CH, Kang YR, Seo MK, Kang MK, Cho JH, et al. Implantable cardioverter-defibrillator implantation in a patient with atrial standstill. Yonsei Med J. 2009. 50:156–159.