Copyright © 2003 by the European Society of Cardiology.
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The ajmaline challenge in Brugada syndrome: Diagnostic impact, safety, and recommended protocol
Hospital of the Westfälische Wilhelms-University, Department of Cardiology and Angiology, Institute for Arteriosclerosis Research, Münster, Germany
* Corresponding author: Sascha Rolf, MD, Universitätsklinikum Münster, Medizinische Klinik und Poliklinik C, Kardiologie und Angiologie, Albert-Schweitzer-Str. 33, D-48145 Münster, Germany. Tel.: +49-251-8347580; fax: +49-251-8348640
E-mail address: srolf{at}uni-muenster.de
Received 17 December 2002; revised 17 February 2003; accepted 26 February 2003
Aims The diagnostic ECG pattern in Brugada syndrome (BS) can transiently normalize and may be unmasked by sodium channel blockers such as ajmaline. Proarrhythmic effects of the drug have been well documented in the literature. A detailed protocol for the ajmaline challenge in Brugada syndrome has not yet been described. Therefore, we prospectively studied the risks of a standardized ajmaline test.
Methods and results During a period of 60 months, 158 patients underwent the ajmaline test in our institution. Ajmaline was given intravenously in fractions (10mg every two minutes) up to a target dose of 1mg/kg. In 37 patients (23%) the typical coved-type ECG pattern of BS was unmasked. During the test, symptomatic VT appeared in 2 patients (1.3%). In all other patients, the drug challenge did not induce VT if the target dose, QRS prolongation >30%, presence/appearance of the typical ECG, or the occurrence of premature ventricular ectopy were considered as end points of the test. A positive response to ajmaline was induced in 2 of 94 patients (2%) with a normal baseline ECG, who underwent evaluation solely for syncope of unknown origin.
Conclusion The ajmaline challenge using a protocol with fractionated drug administration is a safe method to diagnose BS. Because of the potential induction of VT, it should be performed under continuous medical surveillance with advanced life-support facilities. Due to the prognostic importance all patients with aborted sudden death orunexplained syncope without demonstrable structural heart disease and family members of affected individuals should presently undergo drug testing for unmasking BS.
Key Words: Brugada syndrome • Ajmaline challenge • Test protocol • Proarrhythmia • Safety
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