ajmaline and Heart-Arrest

Pharmacologic challenge with sodium channel blockers is part of the diagnostic workout in patients with suspected Brugada syndrome. The test is overall considered safe but both ajmaline and flecainide detain well known pro-arrhythmic properties. Moreover, the treatment of patients with life-threatening arrhythmias during these diagnostic procedures is not well defined. Current consensus guidelines suggest to adopt cautious protocols interrupting the sodium channel blockers as soon as any ECG alteration appears. Nevertheless, the risk of life-threatening arrhythmias persists, even adopting a safe and cautious protocol and in absence of major arrhythmic risk factors. The authors revise the main published case studies of sodium channel blockers challenge in adults and in children, and summarize three cases of untreatable ventricular arrhythmias discussing their management. In particular, the role of advanced cardiopulmonary resuscitation with extra-corporeal membrane oxygenation is stressed as it can reveal to be the only reliable lifesaving facility in prolonged cardiac arrest.

Topics: Action Potentials; Adolescent; Adult; Aged; Aged, 80 and over; Ajmaline; Brugada Syndrome; Cardiopulmonary Resuscitation; Child; Electrocardiography; Extracorporeal Membrane Oxygenation; Female; Flecainide; Heart Arrest; Heart Conduction System; Heart Rate; Humans; Male; Middle Aged; Predictive Value of Tests; Risk Factors; Sodium Channel Blockers; Tachycardia, Ventricular; Treatment Outcome; Ventricular Fibrillation; Young Adult

Topics: Adult; Aged; Ajmaline; Electrocardiography; Heart Arrest; Humans; Male; Middle Aged; Tachycardia; Verapamil

Topics: Adult; Ajmaline; Angina Pectoris; Clinical Trials as Topic; Diagnosis, Differential; Electric Countershock; Female; Heart Arrest; Humans; Intensive Care Units; Lidocaine; Male; Middle Aged; Monitoring, Physiologic; Myocardial Infarction; Pacemaker, Artificial; Prognosis; Propranolol; Resuscitation; Ventricular Fibrillation

Topics: Ajmaline; Heart Arrest; Humans; Japan; Prognosis; Risk Factors

Brugada syndrome is a disease characterized by a specific electrocardiographic pattern and an increased risk of sudden cardiac death. We present this case with the updated literature to emphasise the need to consider the diagnosis of Brugada syndrome in patients admitted to the emergency ward with sudden cardiac arrest.. A 16-year-old female patient was admitted to the emergency ward with complaints of weakness and abdominal pain, and she had four cardiac arrests during her evaluation period. She was referred to our clinic for permanent pacemaker implantation. She was on a temporary pace maker after having had C-reactive protein. Her physical exam was normal except for bilaterally decreased lung sounds. Lung x-ray and computed tomography, which were performed by another institution, revealed minimal pleural effusion and nothing else of significance. Blood and peritoneal fluid samples were sterile. Echocardiographic exam and cardiac enzymes were also in the normal ranges. Electrocardiographic showed incomplete right branch block in leads V1 and V2. An ajmaline test revealed specific electrocardiographic findings of the type I Brugada pattern. We proposed implanting an implantable cardioverter defibrillator to the patient as there were positive findings on the ajmaline test as well as a history of sudden cardiac arrest. After this treatment proposal, the patient's family admitted that she had taken a high dose of verapamil and thus, the encountered bradycardia was associated with verapamil overuse. The ajmaline test was repeated as it was contemplated that the previous positive ajmaline test had been associated with verapamil overuse. Implantable cardioverter defibrillator implantation was proposed again as there was a history of sudden cardiac arrest; however, the family did not consent to implantable cardioverter defibrillator, and the patient was discharged and followed up.. Brugada syndrome should be considered for patients who are admitted to the emergency ward with sudden cardiac arrest though surface electrocardiographic is normal. If there is a suspicion of Brugada syndrome, repeated electrocardiographic should be performed on different occasions. Diagnosis can be clarified by upper costal electrocardiographic or by administering Na channel blockers during electrocardiographic performance.

Topics: Adolescent; Ajmaline; Anti-Arrhythmia Agents; Brugada Syndrome; Diagnosis, Differential; Electrocardiography; Female; Genetic Testing; Heart Arrest; Humans; Precipitating Factors; Sodium Channel Blockers; Suicide, Attempted; Treatment Outcome; Verapamil

Topics: Ajmaline; Anti-Arrhythmia Agents; Brugada Syndrome; Heart Arrest; Humans; Lip

This study evaluated the yield of ajmaline testing and assessed the occurrence of confounding responses in a large cohort of families with unexplained cardiac arrest (UCA) or sudden unexplained death (SUD).. Ajmaline testing to diagnose Brugada syndrome (BrS) is routinely used in the evaluation of SUD and UCA, but its yield, limitations, and appropriate dosing have not been studied in a large cohort.. We assessed ajmaline test response and genetic testing results in 637 individuals from 482 families who underwent ajmaline testing for SUD or UCA.. Overall, 89 individuals (14%) from 88 families (18%) had a positive ajmaline test result. SCN5A mutations were identified in 9 of 86 ajmaline-positive cases (10%). SCN5A mutation carriers had positive test results at significantly lower ajmaline doses than noncarriers (0.75 [range: 0.64 to 0.98] mg/kg vs. 1.03 [range: 0.95 to 1.14] mg/kg, respectively; p < 0.01). In 7 of 88 families (8%), it was concluded that the positive ajmaline response was a confounder, either in the presence of an alternative genetic diagnosis accounting for UCA/SUD (5 cases) or noncosegregation of positive ajmaline response and arrhythmia (2 cases). The rate of confounding responses was significantly higher in positive ajmaline responses obtained at >1 mg/kg than in those obtained at ≤1 mg/kg (7 of 48 vs. 0 of 41 individuals; Fisher's exact test: p = 0.014).. In line with previous, smaller studies, a positive ajmaline response was observed in a large proportion of UCA/SUD families. Importantly, our data emphasize the potential for confounding possibly false-positive ajmaline responses in this population, particularly at high doses, which could possibly lead to a misdiagnosis. Clinicians should consider all alternative causes in UCA/SUD and avoid ajmaline doses >1 mg/kg.

Topics: Administration, Intravenous; Adult; Ajmaline; Brugada Syndrome; Death, Sudden, Cardiac; Diagnostic Errors; Female; Genetic Testing; Heart Arrest; Heterozygote; Humans; Male; Middle Aged; Mutation; NAV1.5 Voltage-Gated Sodium Channel; Pedigree; Phenotype; Ventricular Fibrillation; Voltage-Gated Sodium Channel Blockers

Topics: Aged; Ajmaline; Anti-Arrhythmia Agents; Brugada Syndrome; Defibrillators, Implantable; Electrocardiography; Female; Heart Arrest; Humans; Patient Positioning; Ventricular Fibrillation

Topics: Ajmaline; Angioplasty, Balloon, Coronary; Cardiac Catheterization; Cardiopulmonary Resuscitation; Coronary Angiography; Coronary Circulation; Coronary Stenosis; Heart Arrest; Humans; Hypothermia, Induced; Male; Medication Errors; Middle Aged; Recovery of Function; Retreatment; Risk Assessment

The aim of this study was to perform quantitative signal analysis of high-resolution body surface potential mapping (BSPM) recordings to assess its usefulness for the electrocardiographic characterization of patients with Brugada syndrome. The diagnostic value of the QRS integral and of the gradient of the ST segment have not been elucidated in Brugada syndrome.. In 27 subjects (16 with Brugada syndrome and 11 healthy subjects), 120-lead BSPMs were recorded at baseline and after pharmacological provocation with intravenous administration of ajmaline (1 mg/kg). The recordings were analyzed for two regions outside the positions of the standard ECG leads: the right precordial leads (RPL) on the second and third intercostal space (high RPL) and the left precordial leads (LPL) between the fifth and seventh intercostal space (low LPL).. At baseline, in high RPL regions, patients with Brugada syndrome showed more positive QRS integrals (-5+/-8 vs. -16+/-8 mV ms) and a steeper negative ST segment gradient (-0.62+/-0.41 vs. -0.29+/-0.40 mV/s) compared to healthy subjects, P<0.001. In contrast, in low LPL regions, reduced QRS integrals and positive ST segment gradients were observed. These ECG signs were even more pronounced after intravenous ajmaline and showed a better discrimination for patients with Brugada syndrome than differences in RPL or LPL during baseline, respectively.. In the left precordial leads, patients with Brugada syndrome showed ECG changes which were reversed in relation to the ECG changes observed in right precordial leads. BSPM measurement is a useful tool to improve the understanding of the electrocardiographic changes in the Brugada syndrome.

Topics: Adult; Aged; Ajmaline; Body Surface Potential Mapping; Case-Control Studies; Electrocardiography; Female; Heart Arrest; Humans; Male; Middle Aged; NAV1.5 Voltage-Gated Sodium Channel; Polymorphism, Single-Stranded Conformational; Prospective Studies; Risk; Signal Processing, Computer-Assisted; Sodium Channel Blockers; Sodium Channels; Statistics, Nonparametric; Syndrome; Ventricular Fibrillation

In a case report, a Tachmalcor intoxication with a dose of 18 mg/kg body weight is described. This dose caused a ventricular flutter in the patient which lasted for a total of 10 hours, despite intensive treatment. The treatment began approximately three hours after the intoxication and concentrated on therapy of the ventricular tachycardia. The use of Xylocitin 2%, defibrillation, glucagon and sodium chloride is recommended with such symptoms. Additionally, we used hemoperfusion for drug elimination. Despite the cardiac rhythm disorder of such duration, no neurological deficiencies were observed in the patient. Intoxications caused by these drugs in normal intensive therapies are extremely rare and for this reason treatment can often be very problematic. The following article reports on the successful therapy of one such patient.

Topics: Adult; Ajmaline; Anti-Arrhythmia Agents; Critical Care; Dose-Response Relationship, Drug; Drug Overdose; Heart Arrest; Humans; Suicide, Attempted

18 patients with sinus bradycardia (8 SB) and tachycardia-bradycardia syndrome (10 TBS) were investigated using various vagan reflex manoeuvres, atrial pacing (AP), pharmacological tests and His bundle (HB) recordings, to assess autonomic influences, sinus node function and atrioventricular (AV) conduction. Three types of responses (R) were defined as normal (N), supernormal (SN), poor autonomic (PA). Poor reflex responses to vagal manoeuvres, performed in 12 patients, have no statistical significance. MxCSRT at AP suppression was measured in 13 patients: it was normal (less than or equal to 500 msec) in 8 and increased (from 680 to 4,200 msec) in 5 patients with appearance of junctional escapes. Moreover, AP suppression revealed a sinoatrial block (SAB) in 1 patient with normal MxCSRT. Isoprenaline, administered intravenously (3-6 mug) in 9 patients, showed 4 NR, 3 PAR und 2 SNR (unusual sinus tachycardia, 1; atrial fibrillation, 1). Atropine (0.5-1 mg), used in 15 patients, revealed 5 PAR and 1 SNR. Prostigmine (0.5 mg), used in 11 patients, induced 6 NR and 5 PAR. Lanatosid C (0.08 mg), administered in 16 patients, showed 10 NR, 5 PAR and 1 SNR. Finally, ajmaline (100 mg), given in 13 patients, revealed 5 junctional rhythms and one 2:1 SAB. HB recorded in 17 patients showed an increase of AH interval (greater than 140 msec) in 5 patients and a slight increase (60 msec) of HV interval in 2 patients. Three patients developed 2nd-degree AV block at paced rates greater than or equal to 110/min. Abnormal responses at AP suppression and reduced drug responses were noted in 5 patients suffering from Adam-Stokes attacks; a permanent pacemaker was inserted in 4 of these 5 patients. In conclusion, provocative tests, in 18 patients with SB or TBS, suggest a diffuse process disease involving the autonomic function of both sinus node and AV junction (11 patients) and the AV system (6 patients). These immediate results must be correlated with histological findings in the conduction system, as shown in one of our cases previously reported.

Topics: Adult; Aged; Ajmaline; Arrhythmia, Sinus; Atropine; Blood Pressure; Bradycardia; Bundle of His; Digitalis Glycosides; Female; Heart Arrest; Heart Conduction System; Heart Rate; Humans; Isoproterenol; Male; Middle Aged; Neostigmine; Pacemaker, Artificial; Sinoatrial Block

Topics: Adolescent; Ajmaline; Anesthetics, Local; Aniline Compounds; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Diethylamines; Drug Synergism; Heart Arrest; Humans; Indenes; Male; Seizures

Topics: Ajmaline; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Bretylium Compounds; Drug Synergism; Electrocardiography; Heart Arrest; Heart Ventricles; Humans; Hypotension; Lidocaine; Phenytoin; Propranolol; Tosyl Compounds

Topics: Ajmaline; Electrocardiography; Heart Arrest; Heart Block; Humans; Iatrogenic Disease; Injections, Intravenous; Rauwolfia; Tachycardia; Tachycardia, Supraventricular; Toxicology

Topics: Ajmaline; Heart Arrest; Humans; Rauwolfia