Key result
Ajmaline testing with high right precordial leads increases Brugada syndrome diagnostic yield by ~16%.
Why the study?
Familial evaluation after sudden arrhythmic death syndrome (SADS) may identify relatives at risk, but the impact of systematic ajmaline provocation testing using high right precordial leads on the diagnostic yield of Brugada syndrome required assessment.
Does systematic ajmaline provocation testing with high right precordial leads improve the diagnostic yield of Brugada syndrome in relatives of sudden arrhythmic death syndrome victims?
Observational (n=911)
Does systematic ajmaline provocation testing with high right precordial leads improve the diagnostic yield of Brugada syndrome in relatives of sudden arrhythmic death syndrome victims?
Answers are grounded in this paper and cite their sources.
Systematic ajmaline provocation testing with high right precordial leads substantially increases the detection of Brugada syndrome in relatives of SADS victims.
BACKGROUND: Familial evaluation after a sudden death with negative autopsy (sudden arrhythmic death syndrome; SADS) may identify relatives at risk of fatal arrhythmias. OBJECTIVES: This study aimed to assess the impact of systematic ajmaline provocation testing using high right precordial leads (RPLs) on the diagnostic yield of Brugada syndrome (BrS) in a large cohort of SADS families. METHODS: Three hundred three SADS families (911 relatives) underwent evaluation with resting electrocardiogram using conventional and high RPLs, echocardiography, exercise, and 24-h electrocardiogram monitor. An ajmaline test with conventional and high RPLs was undertaken in 670 (74%) relatives without a familial diagnosis after initial evaluation. Further investigations were guided by clinical suspicion. RESULTS: An inherited cardiac disease was diagnosed in 128 (42%) families and 201 (22%) relatives. BrS was the most prevalent diagnosis (n = 85, 28% of families; n = 140, 15% of relatives). Ajmaline testing was required to unmask the BrS in 97% of diagnosed individuals. The use of high RPLs showed a 16% incremental diagnostic yield of ajmaline testing by diagnosing BrS in an additional 49 families. There were no differences of the characteristics between individuals and families with a diagnostic pattern in the conventional and the high RPLs. On follow-up, a spontaneous type 1 Brugada pattern and/or clinically significant arrhythmic events developed in 17% (n = 25) of the concealed BrS cohort. CONCLUSIONS: Systematic use of ajmaline testing with high RPLs increases substantially the yield of BrS in SADS families. Assessment should be performed in expert centers where patients are counseled appropriately for the potential implications of provocation testing.
No takes yet. Share an insight, caveat, or question.
Papadakis et al. (2018) conducted an observational in Sudden arrhythmic death syndrome (SADS) (n=911). Ajmaline provocation testing using high right precordial leads vs. Conventional right precordial leads was evaluated on Diagnostic yield of Brugada syndrome. Systematic ajmaline provocation testing using high right precordial leads provided a 16% incremental diagnostic yield for Brugada syndrome, identifying an additional 49 families.
Synapse has enriched 10 related papers. Consider them for comparative context: