Unmasked by Fever: Diagnosing Brugada Syndrome After Ventricular Fibrillation Arrest

A 65-year-old man presented to the emergency department after he was resuscitated from cardiac arrest due to ventricular fibrillation. Coronary angiography demonstrated no evidence of coronary artery disease. Follow-up electrocardiograms (ECGs) were also unremarkable until the patient developed a fever, and a new ECG demonstrated a rapidly upsloping ST-segment followed by a downsloping, coved ST-segment in leads V1-V2. The diagnosis of Brugada syndrome was made after a procainamide challenge. The Brugada pattern on ECG can be transient and can manifest in the setting of fever or after taking medications with sodium channel blocking effects.