gms | German Medical Science

33rd International Congress on Electrocardiology

International Society of Electrocardiology

Ajmaline challenge in patients suspicious of Brugada syndrome

Meeting Abstract

  • corresponding author presenting/speaker C. Veltmann - University Mannheim, Mannheim, Germany
  • R. Schimpf - University Mannheim, Mannheim, Germany
  • C. Echternach - University Mannheim, Mannheim, Germany
  • J. Kuschyk - University Mannheim, Mannheim, Germany
  • F. Streitner - University Mannheim, Mannheim, Germany
  • M. Borggrefe - University Mannheim, Mannheim, Germany
  • C. Wolpert - University Mannheim, Mannheim, Germany

33rd International Congress on Electrocardiology. Cologne, 28.06.-01.07.2006. Düsseldorf, Köln: German Medical Science; 2007. Doc06ice127

The electronic version of this article is the complete one and can be found online at:

Published: February 8, 2007

© 2007 Veltmann et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Intravenous ajmaline challenge is used to identify patients with Brugada syndrome if the diagnostic type I ECG pattern is not overt in the basal ECG. The aim of this study was to evaluate the diagnostic yield, safety and side effects of intravenous ajmaline challenge in 236 consecutive patients with syncope of unknown origin, family history of SCD, idiopathic VF or suspicious basal ECG.

Methods: In 236 patients (mean age 43 +/- 23 years, 139 males) suspicious of Brugada syndrome intravenous ajmaline was infused with a maximal dose of 1mg/kg body weight within 5-10 minutes under continuous ECG monitoring following the recommendation of the Brugada consensus conference. Criteria for termination of the test were appearance of the diagnostic type I ECG pattern of Brugada syndrome and furthermore an increase of the QRS duration of more than 30%, high degree AV-block or the development of ventricular premature beats or tachycardia. In 66% of the cases the test was performed due to a syncope of unknown origin, in 14% due to abnormal basal ECG, in 8% because of a family history of sudden cardiac death or Brugada syndrome, in 9% due to palpitations and nsVT and in 3% because of aborted sudden cardiac death.

Results: In 42 patients (17%) ajmaline challenge was positive with development of a diagnostic type I ECG. In the remaining 194 patients the test was negative. In 64% of the patients the test was stopped at the maximal ajmaline dose, in 10% prematurely due to increase of the QRS duration and in 9% due the premature ventricular contractions. In one patient non-sustained polymorphic VT were observed, which did not need further medical treatment.

Conclusions: Ajmaline challenge can safely be performed under continuous monitoring during drug application. The risk of serious side effects using this protocol is very low (0.4%). However, due to the potential risk of ventricular tachyarrhythmias ajmaline challenge should only be performed in the clinical setting.