Temperature-Induced ICD Malfunction in a Patient With Brugada Syndrome.

BACKGROUND

Brugada syndrome is associated with life-threatening arrhythmias and requires implantable cardioverter-defibrillator (ICD) placement, but inappropriate shocks remain a clinical challenge.

CASE SUMMARY: A 43-year-old male firefighter with Brugada syndrome and an automated ICD experienced both appropriate and inappropriate shocks. The shocks occurred primarily during duty in high-temperature environments. Device interrogation revealed the false shocks were due to T-wave oversensing triggered by elevated body temperature. True ventricular tachycardia episodes were also recorded during sleep. The ICD was reprogrammed, and temperature exposure precautions were advised.

DISCUSSION: This case demonstrates the impact of environmental heat exposure on electrocardiogram morphology and ICD performance in patients with Brugada syndrome. It emphasizes the need for individualized programming and occupational risk assessment.

TAKE-HOME MESSAGES: T-wave oversensing from elevated temperature can trigger inappropriate ICD shocks in patients with Brugada syndrome. Individualized ICD settings and environmental risk management are essential in high-risk occupations.