Ajmaline Challenge Test for Brugada Syndrome.
Your doctor has recommended that you have an Ajmaline challenge. The purpose of this test is to see if you are likely to have Brugada syndrome, a disorder that can potentially affect the heart rhythm.
Some people with Brugada syndrome may be at risk of developing a fast heart rhythm (arrhythmia). This can cause symptoms such as dizziness, shortness of breath, chest pain, collapse or even death in rare cases. If you have a close family member who has either been diagnosed with the condition or who has died young from a suspected heart condition, it is very important that all remaining relatives are screened for Brugada syndrome. Ajmaline is a drug used in this test as it shows up ECG changes in patients with Brugada syndrome. In patients with normal cardiac cells Ajmaline has little or no effect on the ECG.
What happens before your Ajmaline challenge?
We ask that you do not eat or drink for 4 hours prior to your appointment time, please inform us if you are diabetic.
What happens during your Ajmaline challenge?
You will arrive at 2 South East Cardiology Day Ward and we will ensure we have all the appropriate documentation we require to perform your procedure. We will take you to the procedure area where a doctor will see you and obtain informed consent to go ahead with the test, once we have confirmed you understand the procedure and, very uncommon but possible, associated risks. If you have any worries or questions please do not be afraid to ask, it is important you tell your doctor or nurse if you have any allergies or if you have had a previous reaction to any drugs or other tests.
Just before the procedure, the nurse will help you get ready and will perform various ECGs (electrical trace of your heart). The nurse or doctor will insert a small needle (cannula) into a vein in either your hand or arm. The Ajmaline will be injected through the cannula while your ECG is recorded continuously. The drug is given over approximately 10 minutes, and you will be monitored for 3 hours after the infusion is complete. By this time all of the Ajmaline should be out of your system and even if you have been shown to have the changes associated with Brugada syndrome, your ECG should have returned to normal.
We will then remove your cannula and ensure you have recovered fully before you go home.
Side effects and risks of Ajmaline
The Ajmaline challenge is safe. However, as with any procedure, there are potential risks that may occur either during or after the procedure. Complications with this procedure are very rare, they can be treated, and are rarely life-threatening.
It is common (and harmless) to experience a metallic taste in your mouth while you are being given the Ajmaline. You may also experience some visual disturbances such as double or blurred vision. Such side effects usually resolve quickly once the infusion is completed. Very rarely the Ajmaline may cause your heart to go into a fast heart rhythm. When this does happen it often needs no treatment while we wait for the drug to wear off. Very rarely this heart rhythm may require urgent treatment with an electrical shock, chest
compressions and/or an antidote to reverse the effects of the Ajmaline. For this reason, the test is performed in an environment where all these resources and experienced staff are available. No cases of death have ever been reported as a result of an Ajmaline challenge worldwide.
Your doctor will only recommend you have an Ajmaline challenge if he/she feels that the benefits clearly outweigh the risks.
Alternatives
Other drugs can be used to test for Brugada syndrome but these take longer to get out of your system, so they require patients to be monitored for a longer period of time and any side effects may last longer. For that reason many hospitals worldwide use Ajmaline for this test.
After the Ajmaline challenge
You should be able to go home around 4 hours after the test. You are allowed to drive yourself to and from the hospital. In the rare case where you have had an electrical shock to treat a fast rhythm, you will need to be monitored for a longer period of time and will not be allowed to drive home.
Your ECG taken during your Ajmaline challenge will often need to be reviewed after the test by a specialist doctor to determine the result, so it may be that the doctor giving you the drug will not be able to tell you the final result of the test immediately. However, you will be told the result of your test either by phone, letter or in clinic.