LAUSR

The prompt recognition and treatment of fevers and arrhythmias in patients with Brugada syndrome and Introduction The eponymous syndrome first described by the Brugada brothers in the early 1990s consists of characteristic ST abnormalities and an increased risk of sudden cardiac death due to ventricular arrhythmias. Since that time, further genetic research has implicated hundreds of variants in 17 genes with mutations in SCN5A, coding for voltage-gated sodium channels, accounting for the majority of genotyped patients. Various triggers have been associated with the development of ventricular fibrillation (VF) in this patient population, including fever and alcohol intake. We present a case of electrical storm in the setting of acute febrile illness in a patient with Brugada syndrome and COVID-19 infection. COVID-19 infection is crucial for favorable outcomes. Case report A58-year-oldwomanwith a history of hypertension, diabetes mellitus, and Brugada syndrome, for which she underwent implantable cardioverter-defibrillator (ICD) implantation in 2017, presented following a 3-day febrile illness and, on the day of presentation, multiple syncopal episodes. She had previously had a syncopal episode in 2019 that occurred in the setting of VF that was terminated by a single shock from her device. Interrogation of her ICD in the emergency department revealed multiple episodes of VF, some of which were nonsustained, as well as 7 episodes that were terminated by appropriate ICD shocks. The fever persisted after admission despite the use of antipyretics, with a maximum temperature of 101.7 F in the first 24 hours. During these febrile periods, she continued to have additional episodes of VF requiring shock termination (Figure 1). Rapid nasal swab testing in