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