title: Procainamide infusion in the evaluation of unexplained cardiac arrest: from the Cardiac Arrest Survivors with Preserved Ejection Fraction Registry (CASPER).
abstract: BACKGROUND
  Provocative testing with sodium channel blockers is advocated for the evaluation of unexplained cardiac arrest (UCA) with the primary purpose of unmasking the typical ECG features of Brugada syndrome. The Cardiac Arrest Survivors with Preserved Ejection Fraction Registry (CASPER) systematically assesses subjects with UCA or a family history of sudden death (FHSD).
  
  
  OBJECTIVE
  The purpose of this study was to determine the clinical yield of procainamide infusion in a national registry of subjects with either UCA or a FHSD.
  
  
  METHODS
  Subjects with either UCA or a FHSD without evidence of a Brugada pattern at baseline underwent procainamide testing (15 mg/kg to a maximum of 1 g at 50 mg/min). A test was considered positive for Brugada pattern if there was an increase in ST elevation >1 mm or if there was >1 mm of new ST elevation in leads V1 and/or V2. Genetic testing was performed on the basis of phenotype detection.
  
  
  RESULTS
  Procainamide testing was performed in 174 subjects (age 46.8 ± 15.4 years, 47% female). Testing provoked a Brugada pattern in 12 subjects (6.9%), 5 of whom had no ST abnormalities at baseline. No subjects with a negative procainamide challenge were subsequently diagnosed with Brugada syndrome. Genetic testing was conducted in 10 of the 12 subjects with a provoked Brugada pattern and was positive for a mutation in the SCN5A gene in 1.
  
  
  CONCLUSIONS
  Irrespective of the baseline ECG, procainamide testing provoked a Brugada pattern in a significant proportion of subjects with UCA or a FHSD, thereby facilitating a diagnosis of Brugada syndrome, and is recommended in the workup of UCA.
authors.affiliation: Queen׳s University, Kingston, Ontario, Canada. Electronic address: riyazsomani@hotmail.com.
authors.forename: Riyaz
authors.initials: R
authors.lastname: Somani
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Krahn
authors.affiliation: Population Health Research Institute, Hamilton, Ontario, Canada.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Healey
authors.affiliation: University Health Network, Toronto, Ontario, Canada.
authors.forename: Vijay S
authors.initials: VS
authors.lastname: Chauhan
authors.affiliation: University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: David H
authors.initials: DH
authors.lastname: Birnie
authors.affiliation: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Champagne
authors.affiliation: BC Children's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Shubhayan
authors.initials: S
authors.lastname: Sanatani
authors.affiliation: St. Michael's Hospital, University of Toronto, Toronto, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Angaran
authors.affiliation: Department of Pediatrics, Children׳s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Gow
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Santabhanu
authors.initials: S
authors.lastname: Chakrabarti
authors.affiliation: Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Brenda
authors.initials: B
authors.lastname: Gerull
authors.affiliation: Western University, London, Ontario, Canada.
authors.forename: Raymond
authors.initials: R
authors.lastname: Yee
authors.affiliation: Western University, London, Ontario, Canada.
authors.forename: Allan C
authors.initials: AC
authors.lastname: Skanes
authors.affiliation: Western University, London, Ontario, Canada.
authors.forename: Lorne J
authors.initials: LJ
authors.lastname: Gula
authors.affiliation: Western University, London, Ontario, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Leong-Sit
authors.affiliation: Western University, London, Ontario, Canada.
authors.forename: George J
authors.initials: GJ
authors.lastname: Klein
authors.affiliation: University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Gollob
authors.affiliation: Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Mario
authors.initials: M
authors.lastname: Talajic
authors.affiliation: QEII Health Sciences Center, Halifax, Nova Scotia, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Gardner
authors.affiliation: Queen׳s University, Kingston, Ontario, Canada.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Simpson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D053840:Brugada Syndrome / Q000175:diagnosis*; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011342:Procainamide / Q000008:administration & dosage; D011446:Prospective Studies; D012042:Registries; D013318:Stroke Volume; D061567:Voltage-Gated Sodium Channel Blockers; D055815:Young Adult
chemical_list: D061567:Voltage-Gated Sodium Channel Blockers; D011342:Procainamide
keywords: Brugada syndrome; Cardiac arrest; Genetics; Procainamide; Sudden death