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Clinical characteristics and electrophysiologic properties of SCN5A variants in fever-induced Brugada syndrome

Chen, Gan-Xiao, Barajas-Martínez, Hector, Ciconte, Giuseppe, Wu, Cheng-I, Monasky, Michelle M., Xia, Hao, Li, Bian, Capra, John A., Guo, Kai, Zhang, Zhong-He, and others. (2022) Clinical characteristics and electrophysiologic properties of SCN5A variants in fever-induced Brugada syndrome. eBioMedicine, 87 . pp. 1-14. ISSN 2352-3964. (doi:10.1016/j.ebiom.2022.104388) (KAR id:99174)



Brugada syndrome (BrS) is a severe inherited arrhythmia syndrome that can be unmasked by fever.


A multicentre clinical analysis was performed in 261 patients diagnosed with fever-induced BrS, including 198 (75.9%) and 27 (10.3%) patients who received next-generation genetic sequencing and epicardial arrhythmogenic substrate (AS) mapping, respectively.


In fever-induced BrS patients, pathogenic or likely pathogenic (P/LP) SCN5A variant carriers developed fever-induced BrS at a younger age, and more often in females and those of Caucasian descent. They exhibited significant electrophysical abnormalities, including a larger epicardial AS area, and more prolonged abnormal epicardial electrograms. During a median follow-up of 50.5 months (quartiles 32.5–81.5 months) after the diagnosis, major cardiac events (MCE) occurred in 27 (14.4%) patients. Patients with P/LP SCN5A variants had a higher ratio of MCE compared with the rest. Additionally, history of syncope, QRS duration, and Tpe interval could also predict an increased risk for future MCE according to univariate analysis. Multivariate analysis indicated that only P/LP SCN5A variants were independent significant predictors of MCE. Computational structural modelling showed that most variants are destabilizing, suggesting that Nav1.5 structure destabilization caused by SCN5A missense variants may contribute to fever-induced BrS. Interpretation In our cohort, P/LP SCN5A variant carriers with fever-induced BrS are more prevalent among patients of Caucasian descent, females, and younger patients. These patients exhibit aggressive electrophysiological abnormalities and worse outcome, which warrants closer monitoring and more urgent management of fever.

Item Type: Article
DOI/Identification number: 10.1016/j.ebiom.2022.104388
Uncontrolled keywords: Brugada syndrome; Fever; Genetics; Sudden cardiac death; Ventricular arrhythmias
Subjects: R Medicine
Divisions: Divisions > Division of Natural Sciences > Kent and Medway Medical School
SWORD Depositor: JISC Publications Router
Depositing User: JISC Publications Router
Date Deposited: 16 Dec 2022 10:32 UTC
Last Modified: 25 Jan 2023 14:07 UTC
Resource URI: (The current URI for this page, for reference purposes)

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