COVID mRNA Vaccine-induced Fever Unmasks Deadly Brugada Syndrome
Another Mechanism for Vaccine Sudden Death Reported
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Brugada syndrome is a rare but potentially life-threatening inherited disease that predisposes patients to fatal cardiac arrhythmias. The syndrome is characterized by the ECG findings of a right bundle branch block and ST-segment elevations in the right precordial leads (V1-V3). More than 400 mutations in the cardiac SCN5A gene have been identified in people with Brugada syndrome, which is characterized by risk of cardiac arrest, particularly in the setting of fever.
Altermanini et al describe a clear-cut case of syncope with cardiac arrest triggered by fever after COVID-19 mRNA vaccination. They were able to catch the post-arrest ECG and demonstrate the classic Brugada changes.
Altermanini M, Habib M, Hamamyh T, et al. SYNCOPE FOLLOWING PFIZER-BIONTECH (BNT162B2) VACCINATION UNMASKING BRUGADA SYNDROME. J Am Coll Cardiol. 2022 Mar, 79 (9_Supplement) 3340.https://doi.org/10.1016/S0735-1097(22)04331-5
Ittiwut et al described 5 cases of vaccine sudden death that tested positive for mutations in the SCN5A gene. Thus it appears that at least some of the early deaths after vaccination may be related to CN5A mutations in those who may not know they have Brugada syndromes.
Ittiwut C, Mahasirimongkol S, Srisont S, Ittiwut R, Chockjamsai M, Durongkadech P, Sawaengdee W, Khunphon A, Larpadisorn K, Wattanapokayakit S, Wetchaphanphesat S, Arunotong S, Srimahachota S, Pittayawonganon C, Thammawijaya P, Sutdan D, Doungngern P, Khongphatthanayothin A, Kerr SJ, Shotelersuk V. Genetic basis of sudden death after COVID-19 vaccination in Thailand. Heart Rhythm. 2022 Nov;19(11):1874-1879. doi: 10.1016/j.hrthm.2022.07.019. Epub 2022 Aug 5. PMID: 35934244; PMCID: PMC9352648.
Teaching points:
- In patients with known Brugada pattern on ECG, COVID-19 and probably all other vaccines are contra-indicated
- In patients who survive COVID-19 cardiac arrest, they should undergo genetic testing for SCN5A and other channelopathies
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