Ajmaline Testing and the Brugada Syndrome.

Area of Science:

• Cardiology
• Electrophysiology
• Genetics

Background:

• Brugada syndrome (BrS) diagnosis relies on a type 1 ECG pattern, but prevalence is unclear due to spontaneous ECG variability.
• The ajmaline challenge is a provocative test used to unmask the BrS ECG pattern.

Purpose of the Study:

• To evaluate the prevalence of a positive ajmaline challenge for BrS in consecutive patients undergoing electrophysiological evaluation.
• To assess the clinical characteristics and outcomes of patients with a positive ajmaline challenge.

Main Methods:

• Prospective inclusion of 2,456 consecutive patients undergoing ajmaline testing between 2008 and 2019.
• Analysis of ajmaline test results, patient demographics, clinical indications, and follow-up data.
• Comparison of characteristics between patients with positive and negative ajmaline tests.

Main Results:

• In the non-familial screening group (1,714 patients), 10.9% (186 patients) had a positive ajmaline test.
• Positive ajmaline test patients were younger and more frequently male compared to the overall population.
• Syncope was the most common indication for ajmaline testing (38.2%) in patients with positive results.

Conclusions:

• Brugada syndrome was diagnosed in a higher-than-expected proportion of patients undergoing ajmaline testing for diverse cardiovascular symptoms.
• These findings highlight the utility of ajmaline challenge in diagnosing BrS and guiding clinical management and counseling.