Abstract 15458: Incidence of Ventricular Arrhythmias Related to Covid Infection and Vaccination in Patients With Brugada Syndrome: Insights From a Large Italian Multicenter Study

Introduction: Brugada syndrome (BrS) is an inherited channelopathy leading to an increased risk of life-threatening arrhythmias. BrS patients have a dynamic ECG pattern that might be revealed by certain conditions such as fever. Covid infection/vaccination is associated with fever. Therefore, prompt treatment with antipyretic drugs is recommended. Hypothesis: We evaluated the incidence and management of fever-related arrhythmias from Covid infection/vaccination among BrS patients previously implanted with an implantable loop recorder (ILR) or an implantable cardioverter-defibrillator (ICD) and followed by remote monitoring. Methods: 326 patients were retrospectively analyzed in 9 Italian Centers with a dedicated inherited disease ambulatory. All patients had a previously implanted device (ICD/ILR) and remote monitoring. We recorded ventricular arrhythmias (non-sustained VT, VT, FVT, VF) 6-month before Covid infection/vaccination, during Covid infection, at each vaccination, and up to 6-month post-Covid healing or 1-month after the last dose of vaccine. In ICD patients, we documented any device intervention (ATP/shock). Results: Mean age was 48.02±14.08, 240 patients were males (73.6%). 235 patients had an ICD (72.1%), and 91 had an ILR (27.9%). 175 patients had a spontaneous type 1 ECG pattern (53.7%). Fever occurred in 18.4% of all patients. The mean temperature was 38.2±0.6 degrees, 2.76% were hospitalized due to Covid. All patients developing fever received paracetamol, only a minority ibuprofen, antibiotics, and hydroxychloroquine. After Covid, we recorded 2 VT episodes in the same patient treated with paracetamol and hydroxychloroquine. After the 1st, 2nd, and 3rd vaccine doses we recorded: 10 NSVT; 16 NSVT and 2 VT; and 7 NSVT, respectively. After 1-month from the last dose, only 1 patient had an episode of FVT. The overall incidence of sustained VT is 1.2%. No ICD interventions, ATP and shocks, were recorded in the ICD population. Patients with an ILR had no ventricular arrhythmias. Conclusions: From this large multicenter study, fever treatment in patients with BrS is widely performed with paracetamol. The overall incidence of sustained ventricular arrhythmias after Covid infection/vaccination is relatively low.