Life-threatening ventricular arrhythmias during ajmaline challenge in patients with Brugada syndrome: incidence, clinical features, and prognosis.
BACKGROUND
Sustained ventricular arrhythmias (sVAs), such as polymorphic ventricular tachycardia or ventricular fibrillation, can complicate ajmaline challenge in patients with Brugada syndrome (BS).


OBJECTIVE
To assess the incidence of life-threatening sVAs during ajmaline administration in a large series of patients with BS. In addition, clinical characteristics as well as prognosis of these patients were evaluated.


METHODS
All consecutive patients with ajmaline-induced diagnosis of BS were eligible for this study.


RESULTS
A total of 503 patients were included. Nine (1.8%) patients (44% men; mean age 26 ± 18 years) developed a life-threatening sVA during ajmaline challenge. Three patients (33%)were children, and 2 (22%) patients experienced sVAs refractory to the first external defibrillation. One patient underwent venoarterial extracorporeal membrane oxygenation to restore sinus rhythm. Age at the time of ajmaline challenge was significantly lower in patients with sVAs compared with patients without sVAs (26 ± 18 years vs 41 ± 18 years; P = .01). Moreover, patients with sVAs presented more frequently with sinus node dysfunction compared with patients with normal response to ajmaline (22.2% vs 1.4%; P = .01). After a mean follow-up time of 29 ± 8 months, none of the patients who had developed a sVA during ajmaline challenge died suddenly or developed further life-threatening ventricular arrhythmias.


CONCLUSIONS
sVA during ajmaline challenge is not a rare event in BS occurring in 9 (1.8%) patients. Despite its challenging acute treatment, the occurrence of ajmaline-induced sVAs in patients with BS might not identify a category at higher risk for further arrhythmic events.
Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium. Electronic address: giulioconte.cardio@gmail.com.
Giulio
G
Conte
Juan
J
Sieira
Andrea
A
Sarkozy
Carlo
C
de Asmundis
Giacomo
G
Di Giovanni
Gian-Battista
GB
Chierchia
Giuseppe
G
Ciconte
Moises
M
Levinstein
Ruben
R
Casado-Arroyo
Giannis
G
Baltogiannis
Johan
J
Saenen
Yukio
Y
Saitoh
Gudrun
G
Pappaert
Pedro
P
Brugada
D000293:Adolescent; D000328:Adult; D000404:Ajmaline / Q000008:administration & dosage / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects; D001530:Belgium / Q000453:epidemiology; D053840:Brugada Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000503:physiopathology; D013997:Time Factors; D055815:Young Adult
D000889:Anti-Arrhythmia Agents; D000404:Ajmaline
AAD; AV; Ajmaline challenge; BS; Brugada syndrome; ECG; ECMO; ICD; Life-threatening ventricular arrhythmias; Proarrhythmia; QTc; SD; SND; Sudden death; VF; VT; antiarrhythmic drug; atrioventricular; corrected QT; electrocardiographic/electrocardiogram; extracorporeal membrane oxygenator; implantable cardioverter-defibrillator; sVA; sinus node dysfunction; sudden death; sustained ventricular arrhythmia; ventricular fibrillation; ventricular tachycardia