Response to intravenous ajmaline: a retrospective analysis of 677 ajmaline challenges.
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.
Veltmann
Christian
C
11st Department of Medicine-Cardiology, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. christian.veltmann@umm.de
Wolpert
Christian
C
Sacher
Frederic
F
Mabo
Philippe
P
Schimpf
Rainer
R
Streitner
Florian
F
Brade
Joachim
J
Kyndt
Florence
F
Kuschyk
Juergen
J
Le Marec
Herve
H
Borggrefe
Martin
M
Probst
Vincent
V
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*
D000889:Anti-Arrhythmia Agents; D000404:Ajmaline