Skip to main content
SpringerLink
Log in

Ajmaline, Flecainide and Propafenone Can Induce Ventricular Fibrillation in Patients with Brugada Syndrome

  • Chapter
  • First Online:
Arrhythmia Induction in the EP Lab

  • 863 Accesses

Abstract

Brugada syndrome is an inherited arrhythmic disease characterized by a cove-shaped ST elevation pattern in leads V1, V2, and V3 with increased risk of sudden cardiac death, without any associated structural heart disease. In patients with suspected Brugada syndrome, intravenous administration of Class IC antiarrhythmic drugs is a well-known method to unmask the syndrome in cases with non-diagnostic type ECG. The most effective among the three drugs is ajmaline, a potent sodium channel blocker having a short half-life. During injection of ajmaline, life-threatening arrhythmias can occur, like polymorphic ventricular tachycardia or ventricular fibrillation. However, intravenous administration of antiarrhythmic drugs like ajmaline, flecainide, propafenone, procainamide, or disopyramide remains a critical stage in the diagnostic approach of concealed Brugada syndrome.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol. 1992;20:1391–6.

    Article  CAS  Google Scholar 

  2. Antzelevitch C, Brugada P, Borggrefe M, Brugada P, Brugada R, Corrado D, et al. Brugada syndrome: report of the second consensus conference. Circulation. 2005;111:659–70.

    Article  Google Scholar 

  3. Wellens HJ, Bar FW, Vanagt EJ. Death after ajmaline administration. Am J Cardiol. 1980;45:905.

    Article  CAS  Google Scholar 

  4. Wolpert C, Echternach C, Veltmann C, Antzelevitch C, Thomas GP, Spehl S, et al. Intravenous drug challenge using flecainide and ajmaline in patients with Brugada syndrome. Heart Rhythm. 2005;2:254–60.

    Article  Google Scholar 

  5. Conte G, Sieira J, Sarkozy A, et al. Life-threatening ventricular arrhythmias during ajmaline challenge in patients with Brugada syndrome: incidence, clinical features, and prognosis. Heart Rhythm. 2013;10:1869–74.

    Article  Google Scholar 

  6. Therasse D, Sacher F, Petit B. Sodium-channel blocker challenge in the familial screening of Brugada syndrome: safety and predictors of positivity. Heart Rhythm. 2017;14:1442–8.

    Article  Google Scholar 

  7. Dobbels B, De Cleen D, Ector J. Ventricular arrhythmia during ajmaline challenge for the Brugada syndrome. Europace. 2016;18:1501–6.

    Article  Google Scholar 

  8. Gandjbakhch E, Fressart V, Duthoit G. Malignant response to ajmaline challenge in SCN5A mutation carriers: experience from a large familial study. Int J Cardiol. 2014;172:256–8.

    Article  CAS  Google Scholar 

  9. Arnalsteen-Dassonvalle E, Hermida JS, Kubala M, Six I, Quenum S, Leborgne L, et al. Ajmaline challenge for the diagnosis of Brugada syndrome: which protocol? Arch Cardiovasc Dis. 2010;103:570–8.

    Article  Google Scholar 

  10. Yan GX, Antzelevitch C. Cellular basis for the Brugada syndrome and other mechanisms of arrhythmogenesis associated with ST-segment elevation. Circulation. 1999;100:1660–6.

    Article  CAS  Google Scholar 

  11. Jongman JK, Jepkes-Bruin N, Ramdat Misier AR, Beukema WP, Delnoy PP, Oude Lutttikhuis H, et al. Electrical storms in Brugada syndrome successfully treated with isoproterenol infusion and quinidine orally. Neth Heart J. 2007;15:151–5.

    Article  CAS  Google Scholar 

  12. Maury P, Couderc P, Delay M, Boveda S, Brugada J. Electrical storm in Brugada syndrome successfully treated using isoprenaline. Europace. 2004;6:130–3.

    Article  CAS  Google Scholar 

  13. Poli S, Toniolo M, Maiani M, Zanuttini D, Rebellato L, Vendramin I, et al. Management of untreatable ventricular arrhythmias during pharmacologic challenges with sodium channel blockers for suspected Brugada syndrome. Europace. 2018;20:234–42.

    Article  Google Scholar 

  14. Priori SG, Wilde AA, Horie M, Cho Y, Behr ER, Berul C, et al. Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Europace. 2013;15:1389–406.

    Article  Google Scholar 

  15. Matana A, Goldner V, Stanic K. Unmasking effect of propafenone on the concealed form of the Brugada phenomenon. Pacing Clin Electrophysiol. 2000;23:416–8.

    Article  CAS  Google Scholar 

  16. Kasanuki H, Ohnishi S, Ohtuka M, Matsuda N, Nirei T, Isogai R, et al. Idiopathic ventricular fibrillation induced with vagal activity in patients without obvious heart disease. Circulation. 1997;95:2277–85.

    Article  CAS  Google Scholar 

  17. Kose N, Akın F. Ventricular fibrillation developing during the provocation test with propafenone in a patient with Brugada syndrome. Int J Cardiol. 2013;163:S81–S211.

    Google Scholar 

  18. Rodríguez-Mañero M, Namdar M, Sarkozy A, Casado-Arroyo R, Ricciardi D, de Asmundis C, Chierchia GB, Wauters K, Rao JY, Bayrak F, Van Malderen S. Brugada prevalence, clinical characteristics and management of atrial fibrillation in patients with Brugada syndrome. Am J Cardiol. 2013;111:362–7.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiologie et Maladie Vasculaires, Hopital Avicenne, AP-HP, Bobigny, France

    Natalia Petcaru

Authors
  1. Natalia Petcaru
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Electrophysiology Laboratory, Rehabilitation Hospital, Iuliu Hatieganu University of Medicine and Pharmacy 5th Department of Internal Medicine, Cardiology-Rehabilitation, Cluj-Napoca, Romania

    Gabriel Cismaru

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Petcaru, N. (2019). Ajmaline, Flecainide and Propafenone Can Induce Ventricular Fibrillation in Patients with Brugada Syndrome. In: Cismaru, G. (eds) Arrhythmia Induction in the EP Lab. Springer, Cham. https://doi.org/10.1007/978-3-319-92729-9_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-92729-9_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-92728-2

  • Online ISBN: 978-3-319-92729-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation