Ajmaline challenge for the diagnosis of Brugada syndrome: Which protocol?

Summary Background Ajmaline challenge is commonly used for the diagnosis of Brugada syndrome. A slow infusion rate has been recommended in view of the proarrhythmic risk, but the diagnostic value of various infusion rates has not been investigated. Aims To compare rapid and slow ajmaline infusion ra...

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Bibliographic Details
Published in:	Archives of cardiovascular diseases Vol. 103; no. 11; pp. 570 - 578
Main Authors:	Arnalsteen-Dassonvalle, Elise, Hermida, Jean-Sylvain, Kubala, Maciev, Six, Isabelle, Quenum, Serge, Leborgne, Laurent, Jarry, Geneviève
Format:	Journal Article
Language:	English
Published:	Amsterdam Elsevier Masson SAS 01-11-2010 Elsevier
Subjects:	Adolescent Adult Aged Aged, 80 and over Ajmaline - administration & dosage Ajmaline - adverse effects Ajmaline challenge Arythmie ventriculaire Atherosclerosis (general aspects, experimental research) Biological and medical sciences Blood and lymphatic vessels Brugada syndrome Brugada Syndrome - diagnosis Cardiac dysrhythmias Cardiology. Vascular system Cardiovascular Cross-Over Studies Electrocardiography Female France Heart Humans Infusions, Parenteral Internal Medicine Isoproterenol Isoprénaline Male Medical sciences Middle Aged Predictive Value of Tests Prospective Studies Retrospective Studies Syndrome de Brugada Tachycardia, Ventricular - chemically induced Test à l’ajmaline Time Factors Ventricular arrhythmia Ventricular Fibrillation - chemically induced Ventricular Premature Complexes - chemically induced Young Adult France ventricular fibrillation Brugada syndrome NSVT Ventricular arrhythmia ECG VPB VA Isoproterenol Test à l’ajmaline VF BS Ajmaline challenge electrocardiogram Arythmie ventriculaire non-sustained ventricular tachycardia Isoprénaline ventricular tachycardia Syndrome de Brugada ventricular premature beat VT Isoprenaline Arrhythmia Heart disease Cardiovascular disease Ajmaline Diagnosis Cardiology Syndrome
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Summary:	Summary Background Ajmaline challenge is commonly used for the diagnosis of Brugada syndrome. A slow infusion rate has been recommended in view of the proarrhythmic risk, but the diagnostic value of various infusion rates has not been investigated. Aims To compare rapid and slow ajmaline infusion rates and to assess the proarrhythmic risk. Methods The first part of this study prospectively compared rapid and slow infusion rates in terms of results and ventricular arrhythmias. Thirty-two patients (mean age 41 ± 12 years; 26 men) received the two ajmaline challenges on different days. According to randomization, ajmaline (1 mg/kg) was infused at 1 mg/sec or over 10 minutes. The second part of the study retrospectively assessed the prevalence of ventricular arrhythmia during 386 challenges performed at a rapid infusion rate. Results No differences were observed between rapid and slow tests. All patients diagnosed as positive or negative with one test obtained the same result with the other test. Ventricular premature beats were observed in five of 32 patients during the slow challenge and in four of 32 patients during the rapid challenge. No sustained ventricular arrhythmias were observed. Analysis of the 386 tests revealed four episodes of ventricular arrhythmia (two complex ventricular premature beats, one non-sustained ventricular tachycardia and one ventricular fibrillation). Conclusion Slow and rapid infusions of ajmaline have identical diagnostic performances on suspected Brugada electrocardiograms. Owing to the risk of severe proarrhythmia, a slow infusion rate, allowing early discontinuation, should be recommended.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23
ISSN:	1875-2136 1875-2128
DOI:	10.1016/j.acvd.2010.10.007