title: Response to intravenous ajmaline: a retrospective analysis of 677 ajmaline challenges.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors: 11st Department of Medicine-Cardiology, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. christian.veltmann@umm.de
authors: Christian
authors: C
authors: Veltmann
authors: Christian
authors: C
authors: Wolpert
authors: Frederic
authors: F
authors: Sacher
authors: Philippe
authors: P
authors: Mabo
authors: Rainer
authors: R
authors: Schimpf
authors: Florian
authors: F
authors: Streitner
authors: Joachim
authors: J
authors: Brade
authors: Florence
authors: F
authors: Kyndt
authors: Juergen
authors: J
authors: Kuschyk
authors: Herve
authors: H
authors: Le Marec
authors: Martin
authors: M
authors: Borggrefe
authors: Vincent
authors: V
authors: Probst
mesh_terms: D000328:Adult; D000404:Ajmaline / Q000008:administration & dosage / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects; D053840:Brugada Syndrome / Q000150:complications / Q000175:diagnosis*; D004562:Electrocardiography / Q000187:drug effects*; D005260:Female; D005602:France; D005858:Germany; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017180:Tachycardia, Ventricular / Q000139:chemically induced* / Q000175:diagnosis*
chemical_list: D000889:Anti-Arrhythmia Agents; D000404:Ajmaline