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, Pedro Brugada

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Abstract

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.

Original languageEnglish
Pages (from-to)1869-1874
Number of pages6
JournalHeart Rhythm
Volume10
Issue number12
DOIs
Publication statusPublished - Dec 2013

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Ajmaline
Brugada Syndrome
Cardiac Arrhythmias
Incidence
Sick Sinus Syndrome
Extracorporeal Membrane Oxygenation

Keywords

  • Ajmaline challenge
  • Brugada syndrome
  • Life-threatening ventricular arrhythmias
  • Proarrhythmia
  • Sudden death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Conte, G., Sieira, J., Sarkozy, A., De Asmundis, C., Di Giovanni, G., Chierchia, G. B., ... Brugada, P. (2013). Life-threatening ventricular arrhythmias during ajmaline challenge in patients with Brugada syndrome: Incidence, clinical features, and prognosis. Heart Rhythm, 10(12), 1869-1874. https://doi.org/10.1016/j.hrthm.2013.09.060

Life-threatening ventricular arrhythmias during ajmaline challenge in patients with Brugada syndrome : Incidence, clinical features, and prognosis. / Conte, Giulio; Sieira, Juan; Sarkozy, Andrea; De Asmundis, Carlo; Di Giovanni, Giacomo; Chierchia, Gian Battista; Ciconte, Giuseppe; Levinstein, Moises; Casado-Arroyo, Ruben; Baltogiannis, Giannis; Saenen, Johan; Saitoh, Yukio; Pappaert, Gudrun; Brugada, Pedro.

In: Heart Rhythm, Vol. 10, No. 12, 12.2013, p. 1869-1874.

Research output: Contribution to journalArticle

Conte, G, Sieira, J, Sarkozy, A, De Asmundis, C, Di Giovanni, G, Chierchia, GB, Ciconte, G, Levinstein, M, Casado-Arroyo, R, Baltogiannis, G, Saenen, J, Saitoh, Y, Pappaert, G & Brugada, P 2013, 'Life-threatening ventricular arrhythmias during ajmaline challenge in patients with Brugada syndrome: Incidence, clinical features, and prognosis', Heart Rhythm, vol. 10, no. 12, pp. 1869-1874. https://doi.org/10.1016/j.hrthm.2013.09.060
Conte, Giulio ; Sieira, Juan ; Sarkozy, Andrea ; De Asmundis, Carlo ; Di Giovanni, Giacomo ; Chierchia, Gian Battista ; Ciconte, Giuseppe ; Levinstein, Moises ; Casado-Arroyo, Ruben ; Baltogiannis, Giannis ; Saenen, Johan ; Saitoh, Yukio ; Pappaert, Gudrun ; Brugada, Pedro. / Life-threatening ventricular arrhythmias during ajmaline challenge in patients with Brugada syndrome : Incidence, clinical features, and prognosis. In: Heart Rhythm. 2013 ; Vol. 10, No. 12. pp. 1869-1874.
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title = "Life-threatening ventricular arrhythmias during ajmaline challenge in patients with Brugada syndrome: Incidence, clinical features, and prognosis",
abstract = "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.",
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T1 - Life-threatening ventricular arrhythmias during ajmaline challenge in patients with Brugada syndrome

T2 - Incidence, clinical features, and prognosis

AU - Conte, Giulio

AU - Sieira, Juan

AU - Sarkozy, Andrea

AU - De Asmundis, Carlo

AU - Di Giovanni, Giacomo

AU - Chierchia, Gian Battista

AU - Ciconte, Giuseppe

AU - Levinstein, Moises

AU - Casado-Arroyo, Ruben

AU - Baltogiannis, Giannis

AU - Saenen, Johan

AU - Saitoh, Yukio

AU - Pappaert, Gudrun

AU - Brugada, Pedro

PY - 2013/12

Y1 - 2013/12

N2 - 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.

AB - 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.

KW - Ajmaline challenge

KW - Brugada syndrome

KW - Life-threatening ventricular arrhythmias

KW - Proarrhythmia

KW - Sudden death

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