Key result
Ajmaline challenge successfully unmasked infrahisian disease in patients with unexplained syncope and preserved ejection fraction, yielding similar maximum HV intervals in patients with and without baseline ECG conduction abnormalities (108 vs 108 msec, p=0.89).
Why the study?
Does ajmaline challenge during electrophysiological study unmask infrahisian disease in patients with unexplained syncope and preserved ejection fraction, regardless of baseline ECG conduction abnormalities?
Observational (n=16)
No
Does ajmaline challenge during electrophysiological study unmask infrahisian disease in patients with unexplained syncope and preserved ejection fraction, regardless of baseline ECG conduction abnormalities?
Ajmaline challenge during EPS safely unmasks infrahisian conduction disease in a significant proportion of patients with unexplained syncope, even in those without baseline ECG conduction abnormalities, potentially guiding early pacemaker implantation.
May support ajmaline challenge for unmasking infrahisian disease regardless of baseline ECG; leaves open effects on management and outcomes.
Ajmaline challenge is a useful tool to unmask the presence of a infrahisian disease in patients with preserved EF, unexplained syncope and negative workup, even in the absence of conduction disturbances on 12-leads ECG. It is a simple and safe test that may disclose the detection of the disease. In these patients, an earlier pacemaker implantation of a pacemaker, may avoid the consequences of a syncopal recurrence. Values of HV interval > 70 msec in basal conditions and ≥ 100 msec after ajmaline administration seem appropriate to unmask infrahisian disease. Larger population is required to validate this hypothesis.
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Pentimalli et al. (2016) conducted an observational in Recurrent and unexplained syncope with preserved ejection fraction (n=16). Ajmaline challenge vs. Patients without baseline ECG conduction abnormalities (ECG-) was evaluated on Maximum HV interval during a positive ajmaline challenge (p=0.89). Ajmaline challenge successfully unmasked infrahisian disease in patients with unexplained syncope and preserved ejection fraction, yielding similar maximum HV intervals in patients with and without baseline ECG conduction abnormalities (108 vs 108 msec, p=0.89).
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