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Comparison of Ajmaline and Procainamide Provocation Tests in the Diagnosis of Brugada Syndrome.

Cheung, CC; Mellor, G; Deyell, MW; Ensam, B; Batchvarov, V; Papadakis, M; Roberts, JD; Leather, R; Sanatani, S; Healey, JS; et al. Cheung, CC; Mellor, G; Deyell, MW; Ensam, B; Batchvarov, V; Papadakis, M; Roberts, JD; Leather, R; Sanatani, S; Healey, JS; Chauhan, VS; Birnie, DH; Champagne, J; Angaran, P; Klein, GJ; Yee, R; Simpson, CS; Talajic, M; Gardner, M; Yeung-Lai-Wah, JA; Chakrabarti, S; Laksman, ZW; Sharma, S; Behr, ER; Krahn, AD (2019) Comparison of Ajmaline and Procainamide Provocation Tests in the Diagnosis of Brugada Syndrome. JACC Clin Electrophysiol, 5 (4). pp. 504-512. ISSN 2405-5018 https://doi.org/10.1016/j.jacep.2019.01.026
SGUL Authors: Behr, Elijah Raphael Papadakis, Michael

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Abstract

OBJECTIVES: The authors studied the response rates and relative sensitivity of the most common agents used in the sodium-channel blocker (SCB) challenge. BACKGROUND: A type 1 Brugada electrocardiographic pattern precipitated by an SCB challenge confers a diagnosis of Brugada syndrome. METHODS: Patients undergoing an SCB challenge were prospectively enrolled across Canada and the United Kingdom. Patients with no prior cardiac arrest and family histories of sudden cardiac death or Brugada syndrome were included. RESULTS: Four hundred twenty-five subjects underwent SCB challenge (ajmaline, n = 331 [78%]; procainamide, n = 94 [22%]), with a mean age of 39 ± 15 years (54% men). Baseline non-type 1 Brugada ST-segment elevation was present in 10%. A total of 154 patients (36%) underwent signal-averaged electrocardiography, with 41% having late potentials. Positive results were seen more often with ajmaline than procainamide infusion (26% vs. 4%, p < 0.001). On multivariate analysis, baseline non-type 1 Brugada ST-segment elevation (odds ratio [OR]: 6.92; 95% confidence interval [CI]: 3.15 to 15.2; p < 0.001) and ajmaline use (OR: 8.76; 95% CI: 2.62 to 29.2; p < 0.001) were independent predictors of positive results to SCB challenge. In the subgroup undergoing signal-averaged electrocardiography, non-type 1 Brugada ST-segment elevation (OR: 9.28; 95% CI: 2.22 to 38.8; p = 0.002), late potentials on signal-averaged electrocardiography (OR: 4.32; 95% CI: 1.50 to 12.5; p = 0.007), and ajmaline use (OR: 12.0; 95% CI: 2.45 to 59.1; p = 0.002) were strong predictors of SCB outcome. CONCLUSIONS: The outcome of SCB challenge was significantly affected by the drug used, with ajmaline more likely to provoke a type 1 Brugada electrocardiographic pattern compared with procainamide. Patients undergoing SCB challenge may have contrasting results depending on the drug used, with potential clinical, psychosocial, and socioeconomic implications.

Item Type: Article
Additional Information: © 2019. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: Brugada syndrome, arrhythmia, cardiac arrest, sodium channels, sudden cardiac death, Brugada syndrome, arrhythmia, cardiac arrest, sodium channels, sudden cardiac death
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: JACC Clin Electrophysiol
ISSN: 2405-5018
Language: eng
Dates:
DateEvent
April 2019Published
27 March 2019Published Online
31 January 2019Accepted
Publisher License: Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0
Projects:
Project IDFunderFunder ID
G-13-0002775Heart and Stroke Foundation of Canadahttp://dx.doi.org/10.13039/501100000222
G-14-0005732Heart and Stroke Foundation of Canadahttp://dx.doi.org/10.13039/501100000222
UNSPECIFIEDCardiac Risk in the YoungUNSPECIFIED
UNSPECIFIEDRobert Lancaster MemorialUNSPECIFIED
PubMed ID: 31000106
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/110834
Publisher's version: https://doi.org/10.1016/j.jacep.2019.01.026

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