• Heart Rhythm · Dec 2013

    Life-threatening ventricular arrhythmias during ajmaline challenge in patients with Brugada syndrome: incidence, clinical features, and prognosis.

    • Giulio Conte, Juan Sieira, Andrea Sarkozy, Carlo de Asmundis, Giacomo Di Giovanni, Gian-Battista Chierchia, Giuseppe Ciconte, Moises Levinstein, Ruben Casado-Arroyo, Giannis Baltogiannis, Johan Saenen, Yukio Saitoh, Gudrun Pappaert, and Pedro Brugada.
    • Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium. Electronic address: giulioconte.cardio@gmail.com.
    • Heart Rhythm. 2013 Dec 1; 10 (12): 1869-74.

    BackgroundSustained ventricular arrhythmias (sVAs), such as polymorphic ventricular tachycardia or ventricular fibrillation, can complicate ajmaline challenge in patients with Brugada syndrome (BS).ObjectiveTo 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.MethodsAll consecutive patients with ajmaline-induced diagnosis of BS were eligible for this study.ResultsA 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.ConclusionssVA 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.© 2013 Heart Rhythm Society Published by Heart Rhythm Society All rights reserved.

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