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

  • Natalia Petcaru


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.


  1. 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.CrossRefGoogle Scholar
  2. 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.CrossRefGoogle Scholar
  3. 3.
    Wellens HJ, Bar FW, Vanagt EJ. Death after ajmaline administration. Am J Cardiol. 1980;45:905.CrossRefGoogle Scholar
  4. 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.CrossRefGoogle Scholar
  5. 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.CrossRefGoogle Scholar
  6. 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.CrossRefGoogle Scholar
  7. 7.
    Dobbels B, De Cleen D, Ector J. Ventricular arrhythmia during ajmaline challenge for the Brugada syndrome. Europace. 2016;18:1501–6.CrossRefGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. 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.CrossRefGoogle Scholar
  10. 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.CrossRefGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. 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.CrossRefGoogle Scholar
  14. 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.CrossRefGoogle Scholar
  15. 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.CrossRefGoogle Scholar
  16. 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.CrossRefGoogle Scholar
  17. 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. 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.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Natalia Petcaru
    • 1
  1. 1.Cardiologie et Maladie Vasculaires, Hopital Avicenne, AP-HPBobignyFrance

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