skip to main content
Language:
Search Limited to: Search Limited to: Resource type Show Results with: Show Results with: Search type Index

12 Comparison of slow vs. rapid ajmaline infusion protocol for the diagnosis of brugada syndrome (BrS): ten year experience of the Northern Ireland inherited cardiac conditions service (NI ICC)

Heart (British Cardiac Society), 2021, Vol.107 (Suppl 2), p.A13-A14 [Peer Reviewed Journal]

2021 Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. ;ISSN: 1355-6037 ;EISSN: 1468-201X ;DOI: 10.1136/heartjnl-2021-ICS.12

Full text available

Citations Cited by
  • Title:
    12 Comparison of slow vs. rapid ajmaline infusion protocol for the diagnosis of brugada syndrome (BrS): ten year experience of the Northern Ireland inherited cardiac conditions service (NI ICC)
  • Author: Sulaiman, H M ; Brennan, P ; Connolly, H ; McOsker, J ; Jardine, T ; Miur, A
  • Subjects: Patients
  • Is Part Of: Heart (British Cardiac Society), 2021, Vol.107 (Suppl 2), p.A13-A14
  • Description: Introduction BrS is diagnosed in patients with ST-segment elevation with type 1 morphology ≥ 2mm in one or more leads among the right precordial leads V1 and/or V2 positioned in the second, third or fourth intercostal space. This may be spontaneous or after provocation challenge with intravenous administration of a sodium channel blocker (i.e. ajmaline, flecainide, procainamide or pilsicainide). The specific protocol for ajmaline provocation challenge for diagnosis of BrS has been debated between ICC services worldwide. Concerns regarding safety and false positive rates are perceived to be associated with a more rapid infusion protocol. This retrospective observational cohort study describes the safety and positivity rates for patients undergoing ajmaline provocation challenge by both protocols over ten years. Methods Data on consecutive adults undergoing ajmaline challenge test from Mach 2011 to March 2021 were retrospectively collected. Patient demographics, indication for testing, genetic information, adverse events and positivity rates were compared by test protocol used. Slow protocol was defined as total dose of 1mg/kg ajmaline capped at 100mg, given at rate of 10mg/min. Rapid protocol was defined as 1mg/kg ajmaline capped at 100mg given in 10 divided doses over 5 minutes. Results A total of 414 ajmaline challenges were included (251 (61%) slow vs. 163 (39%) rapid protocol) [Mean age 41 ± 16yrs; 50% male]. Indications for conducting the test were a) family history of BrS 182 (44%), b) family history of SADS/SUD 138 (33%), c) OOHCA 26 (6%), d) abnormal ECG 47 (11%) and e) syncope 21 (5%). There was no difference in positivity rate between the two protocols (slow (23%) vs. rapid protocol (17%), p=0.13) [table 1]. Comparison of patients by provocation result regardless of the protocol used showed a predominance of (males, 51% in both groups, p=0.96) and (similar mean age of patients, p=0.91). Positive patients were more likely to have (a family history of BrS, p=0.006) or (an SCN5A genetic variant, p<0.05). Patients whose indication was (a family history of SADS/SUD, p<0.05) or (abnormal ECG, p<0.05) were more likely to yield a negative ajmaline test [table 2]. A single patient experienced ventricular ectopy with the slow protocol. While there were no dysrhythmias with the rapid protocol, two patients experienced QRS broadening necessitating early termination of the protocol but this was not statistically significant. Two patients developed jaundice post provocation with slow protocol, both of which resolved spontaneously.Abstract 12 Table 1 Demographics of patients by ajmaline challenge protocol Group A: Slow protocol (1mg/kg over 10 minutes) Group B: Rapid protocol (1mg/kg over 5 minutes) p-value No of tests, n (%) 251 (61%) 163 (39%) p=0.61 (ns) Age (mean ± sd) years 40 ± 16 43 ± 15 p=0.09 (ns) Gender (male: female) 136 : 115 75 : 88 p=0.10 (ns) Indications:a) Family History of BrSb) Family history of SADS/SUDc) History of OOHCAd) ECG abnormalitye) Unexplained syncope 10578173417 77609134 p=0.28 (ns)p=0.23 (ns)p=0.61 (ns)p=0.08 (ns)p=0.05 (trend) Positive result, n (%) 57 (23%) 27 (17%) p=0.13 (ns) Ventricular Arrhythmia 1 (ventricular ectopy) 0 QRS broadening resulting in shortening of protocol 0 2 Jaundice 2 0 *BrS: Brugada syndrome, SADS/SUD: Sudden arrhythmic death syndrome/Sudden unexplained death, OOHCA: Out of hospital cardiac arrest, ns: non-significant, sig: significant.Abstract 12 Table 2 Comparison of patients by ajmaline challenge result Ajmaline challenge result Age (mean) Gender Male (%) a) Family Hx BrS b) Family Hx of SADS/SUD c) Hx of OOHCA d) ECG abnormality e) Unexplained syncope SCN5A variant positive Positive results 41.2 43/84 (51%) 48/84 (57%) 14/84 (17%) 3/84 (4%) 16/84 (19%) 3/84 (4%) 15/84 (18%) Negative results 41.4 168/330 (51%) 134/330 (41%) 124/330 (38%) 23/330 (7%) 31/330 (9%) 18/330 (5%) 5/330 (2%) p-value p=0.91 (ns) p=0.96 (ns) p=0.006 (trend) p<0.05 (sig) p=0.25 (ns) p<0.05 (sig) p=0.48 (ns) p<0.05 (sig) *BrS: Brugada syndrome, SADS/SUD: Sudden arrhythmic death syndrome/Sudden unexplained death, OOHCA: Out of hospital cardiac arrest, Hx: history, ns: non-significant, sig: significant. Conclusion The NI ICC service have performed 414 ajmaline test over the last ten years. Patients with a family history of BrS are more likely to have a positive provocation challenge, whilst the yield from patients with a family history of SADS/SUD or simply abnormal ECG in the absence of symptoms is low. Our overall positivity rate was 20% with no difference in positivity between the rapid and slow protocols. Both protocols have proven safe to date in our centre, with no significant dysrhythmias or conduction disease identified to date with either protocol. Our incidence of drug induced jaundice was 1 in 207 patients which is higher than previously published and both occurred with the slow protocol. Our data suggests that the rapid protocol is safe and does not result in an increased positivity rate, therefore we will continue with rapid protocol for efficiency in our unit.
  • Publisher: London: BMJ Publishing Group LTD
  • Language: English
  • Identifier: ISSN: 1355-6037
    EISSN: 1468-201X
    DOI: 10.1136/heartjnl-2021-ICS.12
  • Source: ProQuest Central
Back to results list
INSPIRE LIBRARY - TON DUC THANG UNIVERSITY (84-028) 37 755 057 Feedback
19 Nguyen Huu Tho St. Dist.7, HCM thuvien@tdtu.edu.vn

Copyright © 2017 INSPIRE LIBRARY - TON DUC THANG UNIVERSITY

Searching Remote Databases, Please Wait