J Korean Med Sci.  2022 Oct;37(42):e306. 10.3346/jkms.2022.37.e306.

COVID-19 Vaccination-Induced Ventricular Fibrillation in an Afebrile Patient With Brugada Syndrome

• Lim KH
• Park JS

• KMID: 2534759
• DOI: http://doi.org/10.3346/jkms.2022.37.e306

Abstract

A 43-year-old man presented with cardiac arrest 2 days after the second coronavirus disease 2019 (COVID-19) vaccination with an mRNA vaccine. Electrocardiograms showed ventricular fibrillation and type 1 Brugada pattern ST segment elevation. The patient reported having no symptoms, including febrile sensation. There were no known underlying cardiac diseases to explain such electrocardiographic abnormalities. ST segment elevation completely disappeared in two weeks. Although there were no genetic mutations or personal or family history typical of Brugada syndrome, flecainide administration induced type 1 Brugada pattern ST segment elevation. This case suggests that COVID-19 vaccination may induce cardiac ion channel dysfunction and cause life threatening ventricular arrhythmias in specific patients with Brugada syndrome.

Keyword

Brugada Syndrome; Ventricular Fibrillation; COVID-19 Vaccines

Figure

• 

  Fig. 1 Electrocardiogram recorded by the automated external defibrillator. (A) Initially-recorded rhythm showed ventricular fibrillation which was terminated by defibrillator shock therapy. (B) Rhythm strip acquired 5 minutes after the return of sinus rhythm showed coved-type ST segment elevation.

• 

  Fig. 2 Serial ST segment changes recorded by the standard 12-lead ECGs. (A) ECG acquired 2 hours after the cardiac arrest at the emergency department showed coved-type (type 1 Brugada pattern) ST segment elevations in the V1–V2 precordial leads. (B) ECG acquired 8 days after the cardiac arrest showed saddleback-type (type 2 Brugada pattern) ST segment elevations. (C) ECG acquired 14 days after the cardiac arrest showed complete disappearance of ST segment elevations.ECG = electrocardiogram.

• 

  Fig. 3 Serial ST segment changes recorded by the standard 12-lead ECGs using Brugada leads. (A) ECG acquired at baseline showed no significant ST segment elevation. (B) ECG acquired 1 hours after oral flecainide 400 mg single dose administration showed appearance of coved-type (type 1 Brugada pattern) ST segment elevations in the V1–V2 Brugada leads, which were located in the third intercostal space.ECG = electrocardiogram.

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