Ajmaline Testing and the Brugada Syndrome - 27/10/20
Résumé |
Brugada syndrome (BrS) diagnosis requires the presence of a typical type 1 ECG pattern. Owing to the spontaneous ECG variability, the real BrS prevalence in the general population remains unclear.
The aim of the present study was to evaluate the prevalence of positive ajmaline challenge for BrS in a cohort of consecutive patients who underwent electrophysiological evaluation for different clinical reasons. All consecutive patients from 2008 to 2019 who underwent ajmaline testing were prospectively included. A total of 2,456 patients underwent ajmaline testing, 742 (30.2%) in the context of familial screening for BrS. In non-familial screening group (1,714) ajmaline testing resulted positive in 186 (10.9%). Indications for ajmaline testing were: suspicious BrS ECG in 23 cases (12.4%), palpitations in 27 (14.5%), syncope in 71 (38.2%), presyncope in 7 (3.8%), family history of sudden cardiac death in 18 (9.7%), documented ventricular arrhythmias in 12 (6.5%), unexplained cardiac arrest in 4 (2.2%), atrial fibrillation in 16 (8.5%), brady-arrhythmias in 1 (0.5%), and cerebrovascular accidents in 7 (3.7%). Compared with the overall population, ajmaline testing positive patients were younger (42.8 ± 15.5 vs 48.9 ± 20.4; p <0.001) and more frequently male (65.1% vs 56.3%; p = 0.023). Implantable cardioverter defibrillator was implanted in 84 patients (45.2%). During a median follow-up of 42.4 months, 12 appropriate shocks and 13 implantable cardioverter defibrillator related complications were reported. In conclusion, the BrS was diagnosed in an unexpected high proportion of patients that underwent ajmaline testing for a variety of cardiovascular symptoms. This can lead to an adequate counseling and clinical management in BrS patients.
Le texte complet de cet article est disponible en PDF.Highlights |
• | The main finding of the study is the high unexpected burden of Brugada syndrome (BrS) diagnosis after a drug challenge test (10.9%) in a selected population of consecutive patients. |
• | Only a minority of patients (12.4%) presented with a baseline ECG suspicious for BrS. Such a high positive test rate is striking, given the fact that BrS is classically considered to be a rare disease. |
• | Despite BrS diagnosis remains a matter of debate and implantable cardioverter defibrillator placement is indicated only in selected high-risk patients, a positive ajmaline challenge can surely be crucial in further clinical management. In particular avoiding administration of potentially pro-arrhythmic drugs or aggressive treatment of all febrile episodes with antipyretics. |
• | Ajmaline challenge has a crucial role also in asymptomatic BrS patients management and in their family screening. |
Plan
Vol 135
P. 91-98 - novembre 2020 Retour au numéro
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