Europace Advance Access originally published online on July 9, 2009
Europace 2009 11(10):1345-1352; doi:10.1093/europace/eup189
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Sudden Cardiac Death Syndrome
Response to intravenous ajmaline: a retrospective analysis of 677 ajmaline challenges
,*1 1st Department of Medicine-Cardiology, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; 2 Service de Cardiologie, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France; 3 Département de Cardiologie, Hôpital Pontchaillou, Rennes, France; 4 Department of Statistics, University Hospital Mannheim, Mannheim, Germany; 5 I'institut du Thorax, CHU Nantes, Nantes, France
Aims: The diagnostic type I ECG in Brugada syndrome (BS) is often concealed and fluctuates between the diagnostic and non-diagnostic pattern. Challenge with intravenous ajmaline is used to unmask the diagnostic Brugada ECG. The aim of this study was to evaluate the safety of the test and to identify predictors for the response to an intravenous ajmaline challenge.
Methods and results: In four tertiary referral centres, 677 consecutive patients underwent an intravenous ajmaline challenge for diagnosis or exclusion of BS in accordance with the recommendations of the Brugada consensus conferences. Two hundred and sixty-two ajmaline challenges (39%) were positive. Male gender, familial BS, sudden cardiac arrest (SCA), first-degree AV-block, basal saddleback type ECG, and basal right bundle branch block were identified as predictors for a positive ajmaline challenge. A predictor for negative ajmaline test was the absence of ST-segment elevation at baseline. Six of 12 patients who had experienced SCA, and five of 25 patients with a familial sudden death exhibited a positive response to ajmaline. Only one patient (0.15%) developed sustained ventricular tachyarrhythmias (ventricular fibrillation) during ajmaline challenge, which was terminated by a single external defibrillator shock.
Conclusion: Ajmaline challenge is a safe procedure to unmask the electrocardiographic pattern of BS. Electrocardiographic and clinical parameters were identified to predict patients’ response to ajmaline. The results of this study guide the clinician in which setting an ajmaline challenge is an appropriate diagnostic step.
Key Words: Brugada syndrome, ECG, Sodium channel blocker, Ajmaline, Syncope, Familial screening
* Corresponding author. Tel: +49 621 383 2206, Fax: +49 621 383 3061, Email: christian.veltmann{at}umm.de
The first two authors contributed equally to the study.
Manuscript submitted 26 March 2009. Accepted after revision 18 June 2009.
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