Why the study?
Does an ajmaline challenge unmask a type 1 Brugada pattern in a patient with altered ventricular activation from left bundle branch pacing?
Does an ajmaline challenge unmask a type 1 Brugada pattern in a patient with altered ventricular activation from left bundle branch pacing?
Diagnostic Brugada repolarization abnormalities can remain recognizable during an ajmaline challenge despite the altered ventricular activation associated with conduction system pacing.
May warrant caution with ajmaline testing after LBBP; leaves open whether pacing alters Brugada pattern unmasking.
A 67-year-old man with recurrent syncope and chronic right bundle branch block underwent left bundle branch pacing for infra-Hisian atrioventricular block. Because a prior electrocardiogram showed a type 2 Brugada pattern, an ajmaline challenge was performed after device implantation using high-precordial lead positioning. The test unmasked a diagnostic type 1 Brugada pattern during both intrinsic and left bundle branch block-paced beats. This case illustrates that diagnostic Brugada repolarization abnormalities may remain recognizable despite altered ventricular activation associated with conduction system pacing.
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Pastori et al. (2026) studied this question.
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