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OP-197: RESPONSE TO INTRAVENOUS AJMALINE CHALLENGE IN PATIENTS WITH BRUGADA SYNDROME: A SINGLE CENTER EXPERIENCE
S82
Oral Presentations / International Journal of Cardiology 147S2 (2011) S37–S98
leads were removed by using the evolution mechanical dilator sheath (Cook Medical) (Figure 1) with the rotational cutting force only, without laser or radiofrequency energy. Results: Indications for lead removal included cardiac device infection in 23 (48.9%) patients, lead malfunction in the 23 (48.9%) patients and lead displacement in the remaining 1 patient (2.2%). In 21 (44.7%) cases, the extracted device was a pacemaker, and implantable cardioverter defibrillator (ICD) in 26 (55.3%) of them. Among 85 leads, 50 (58.8%) were right ventricular, 28 (32.9%) were atrial and 7 (8.3%) were coronary sinus electrode. The median time from the preceding procedure was 85 months (24–216 months). Complete procedural success with Evolution system alone was achieved in 41 (87.2%) patients (79 leads). Six leads were completely removed with snaring and in four leads, partial success was achieved with a remaining ventricular tip smaller than 1.5 cm. Clinical success was 100%, and all of the patients discharged uneventfully without major complication. Conclusions: Our experience confirms that the mechanical technique with Evolution system is an effective first-line method for chronically implanted pacemaker/ICD leads. Continued investigation is required to evaluate success and complication rates in comparison to with other techniques.
Figure 1. Evolution mechanical dilator sheath.
OP-196 PROPAFENONE CHALLENGE TEST HAD LOW DIAGNOSTIC YIELD IN PATIENTS WITH BRUGADA SYNDROME S. Okutucu, B. Evranos, C. Sabanov, S.G. Fatihoglu, U.N. Karakulak, L. Sahiner, E.B. Kaya, K. Aytemir, G. Kabakci, L. Tokgozoglu, H. Ozkutlu, A. Oto. Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: The diagnostic ECG pattern in Brugada syndrome (BS) might be transiently normal and it could be unmasked by sodium channel blockers, especially with ajmaline challenge test. Aim of this study was to compare ajmalin challenge test with propafenone challenge test. Methods: The study population consisted of 65 patients mean age 34.0±8.4 years, with one or more of the following clinical presentations; sudden cardiac arrest (n = 4), syncope of unknown origin (n = 12), documented VT (n = 5), asymptomatic individuals with a family history of sudden cardiac death (n = 19) or with a suspicious but not diagnostic ECG (n = 25) (incomplete/complete bundle branch block pattern, ‘saddle-type’ ECG with ST segment elevation less than 0.2 mV) during routine examination. Structural heart disease was excluded by clinical history and noninvasive and invasive methods. All patients underwent ajmaline and propafenone challenge in two different days. Ajmaline was given intravenously in fractions to a target dose of 1 mg/kg in five minutes. Results: In 17 patients (26.1%) the typical coved-type ECG pattern of BS was unmasked. During test, no symptomatic VT was detected.
No mortality occurred. Implantable cardioverter defibrillator (ICD) implantation was performed in 7 (41.1%) patients with positive test results. If the results of ajmaline challenge test were accepted as gold standart; the sensitivity of propafenone challenge test was only 41.2% (specificity=81.3%, positive predictive value=43.8, negative predictive value=79.7%). Conclusions: Propafenone challenge test had low diagnostic yield in patients with BS. OP-197 RESPONSE TO INTRAVENOUS AJMALINE CHALLENGE IN PATIENTS WITH BRUGADA SYNDROME: A SINGLE CENTER EXPERIENCE S. Okutucu, B. Evranos, C. Sabanov, U.N. Karakulak, A. Ulgen, L. Sahiner, E.B. Kaya, K. Aytemir, G. Kabakci, L. Tokgozoglu, H. Ozkutlu, A. Oto. Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: The diagnostic ECG pattern in Brugada syndrome (BS) might be transiently normal and it could be unmasked by sodium channel blockers, such as ajmaline. The aim of this study was to evaluate the safety of the test and to identify predictors for the response to an intravenous ajmaline challenge test. Methods: We analyzed 77 patients (mean age 33.2±8.2 years, 54 males) with one or more of the following clinical presentations; sudden cardiac arrest (n = 4), syncope of unknown origin (n = 12), documented VT (n = 5), asymptomatic individuals with a family history of sudden cardiac death (n = 23) or with a suspicious but not diagnostic ECG (n = 33) (incomplete/complete right bundle branch block pattern, ‘saddle-type’ ECG with ST segment elevation less than 0.2 mV) during routine examination. Structural heart disease was excluded by clinical history and noninvasive and invasive methods. Ajmaline was given intravenously at a target dose of 1 mg/kg in five minutes. Results: In 20 patients (26.0%) the typical coved-type ECG pattern of BS was unmasked. During test, no symptomatic VT was detected. No mortality occurred. Implantable cardioverter defibrillator (ICD) implantation was performed in 8 (40.0%) patients with positive test result. Basal saddleback type ECG (OR, 5.67; 95% CI, 1.40–22.92; P =0.015) and basal right bundle branch block (OR, 4.66; 95% CI, 1.54–14.07; P =0.004) were identified as predictors for a positive ajmaline challenge test. Conclusions: The ajmaline challenge test using a protocol with fractionated drug administration is a safe method to diagnose BS. Because of the potential induction of VT, it should be performed under continuous medical surveillance with advanced life-support facilities. Basal saddleback type ECG and basal right bundle branch block were the predictors of the positive ajmaline challenge test. OP-199 THE PROPAFENONE CHALLENGE IN BRUGADA SYNDROME: DIAGNOSTIC IMPACT, SAFETY, AND RECOMMENDED PROTOCOL. A PILOT STUDY V. Camkiran, H. Corut, S.S. Baysal, B. Ersoy, S. Hasirci, I. Atar, F. Yigit, T. Acil, O. Ciftci, H. Muderrisoglu, B. Ozin. Department of Cardiology, Baskent University, Ankara, Turkey Objective: Brugada syndrome is characterized by sudden death secondary to malignant arrhythmias and the presence of ST segment elevation in leads V1 to V3 of patients with structurally normal hearts. These electrocardiographic manifestations are transient in many patients with the syndrome. Provocation tests with sodium channel blockers are often required to unmask ECG abnormalities in Brugada syndrome. We aimed to establish sensitivity, specificity, and safety of propafenone testing using ajmaline testing for control. Methods: The effect of intravenous ajmaline (1 mg/kg over 5 min) and propafenone (1 mg/kg over 5 min) on the ECG was studied in 14 patients with who had Brugada Syndrome suspicions. The test was considered positive if the abnormal coved-type ECG pattern appeared in more than one right precordial lead (V1–V3).
Oral Presentations / International Journal of Cardiology 147S2 (2011) S37–S98
leads were removed by using the evolution mechanical dilator sheath (Cook Medical) (Figure 1) with the rotational cutting force only, without laser or radiofrequency energy. Results: Indications for lead removal included cardiac device infection in 23 (48.9%) patients, lead malfunction in the 23 (48.9%) patients and lead displacement in the remaining 1 patient (2.2%). In 21 (44.7%) cases, the extracted device was a pacemaker, and implantable cardioverter defibrillator (ICD) in 26 (55.3%) of them. Among 85 leads, 50 (58.8%) were right ventricular, 28 (32.9%) were atrial and 7 (8.3%) were coronary sinus electrode. The median time from the preceding procedure was 85 months (24–216 months). Complete procedural success with Evolution system alone was achieved in 41 (87.2%) patients (79 leads). Six leads were completely removed with snaring and in four leads, partial success was achieved with a remaining ventricular tip smaller than 1.5 cm. Clinical success was 100%, and all of the patients discharged uneventfully without major complication. Conclusions: Our experience confirms that the mechanical technique with Evolution system is an effective first-line method for chronically implanted pacemaker/ICD leads. Continued investigation is required to evaluate success and complication rates in comparison to with other techniques.
Figure 1. Evolution mechanical dilator sheath.
OP-196 PROPAFENONE CHALLENGE TEST HAD LOW DIAGNOSTIC YIELD IN PATIENTS WITH BRUGADA SYNDROME S. Okutucu, B. Evranos, C. Sabanov, S.G. Fatihoglu, U.N. Karakulak, L. Sahiner, E.B. Kaya, K. Aytemir, G. Kabakci, L. Tokgozoglu, H. Ozkutlu, A. Oto. Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: The diagnostic ECG pattern in Brugada syndrome (BS) might be transiently normal and it could be unmasked by sodium channel blockers, especially with ajmaline challenge test. Aim of this study was to compare ajmalin challenge test with propafenone challenge test. Methods: The study population consisted of 65 patients mean age 34.0±8.4 years, with one or more of the following clinical presentations; sudden cardiac arrest (n = 4), syncope of unknown origin (n = 12), documented VT (n = 5), asymptomatic individuals with a family history of sudden cardiac death (n = 19) or with a suspicious but not diagnostic ECG (n = 25) (incomplete/complete bundle branch block pattern, ‘saddle-type’ ECG with ST segment elevation less than 0.2 mV) during routine examination. Structural heart disease was excluded by clinical history and noninvasive and invasive methods. All patients underwent ajmaline and propafenone challenge in two different days. Ajmaline was given intravenously in fractions to a target dose of 1 mg/kg in five minutes. Results: In 17 patients (26.1%) the typical coved-type ECG pattern of BS was unmasked. During test, no symptomatic VT was detected.
No mortality occurred. Implantable cardioverter defibrillator (ICD) implantation was performed in 7 (41.1%) patients with positive test results. If the results of ajmaline challenge test were accepted as gold standart; the sensitivity of propafenone challenge test was only 41.2% (specificity=81.3%, positive predictive value=43.8, negative predictive value=79.7%). Conclusions: Propafenone challenge test had low diagnostic yield in patients with BS. OP-197 RESPONSE TO INTRAVENOUS AJMALINE CHALLENGE IN PATIENTS WITH BRUGADA SYNDROME: A SINGLE CENTER EXPERIENCE S. Okutucu, B. Evranos, C. Sabanov, U.N. Karakulak, A. Ulgen, L. Sahiner, E.B. Kaya, K. Aytemir, G. Kabakci, L. Tokgozoglu, H. Ozkutlu, A. Oto. Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: The diagnostic ECG pattern in Brugada syndrome (BS) might be transiently normal and it could be unmasked by sodium channel blockers, such as ajmaline. The aim of this study was to evaluate the safety of the test and to identify predictors for the response to an intravenous ajmaline challenge test. Methods: We analyzed 77 patients (mean age 33.2±8.2 years, 54 males) with one or more of the following clinical presentations; sudden cardiac arrest (n = 4), syncope of unknown origin (n = 12), documented VT (n = 5), asymptomatic individuals with a family history of sudden cardiac death (n = 23) or with a suspicious but not diagnostic ECG (n = 33) (incomplete/complete right bundle branch block pattern, ‘saddle-type’ ECG with ST segment elevation less than 0.2 mV) during routine examination. Structural heart disease was excluded by clinical history and noninvasive and invasive methods. Ajmaline was given intravenously at a target dose of 1 mg/kg in five minutes. Results: In 20 patients (26.0%) the typical coved-type ECG pattern of BS was unmasked. During test, no symptomatic VT was detected. No mortality occurred. Implantable cardioverter defibrillator (ICD) implantation was performed in 8 (40.0%) patients with positive test result. Basal saddleback type ECG (OR, 5.67; 95% CI, 1.40–22.92; P =0.015) and basal right bundle branch block (OR, 4.66; 95% CI, 1.54–14.07; P =0.004) were identified as predictors for a positive ajmaline challenge test. Conclusions: The ajmaline challenge test using a protocol with fractionated drug administration is a safe method to diagnose BS. Because of the potential induction of VT, it should be performed under continuous medical surveillance with advanced life-support facilities. Basal saddleback type ECG and basal right bundle branch block were the predictors of the positive ajmaline challenge test. OP-199 THE PROPAFENONE CHALLENGE IN BRUGADA SYNDROME: DIAGNOSTIC IMPACT, SAFETY, AND RECOMMENDED PROTOCOL. A PILOT STUDY V. Camkiran, H. Corut, S.S. Baysal, B. Ersoy, S. Hasirci, I. Atar, F. Yigit, T. Acil, O. Ciftci, H. Muderrisoglu, B. Ozin. Department of Cardiology, Baskent University, Ankara, Turkey Objective: Brugada syndrome is characterized by sudden death secondary to malignant arrhythmias and the presence of ST segment elevation in leads V1 to V3 of patients with structurally normal hearts. These electrocardiographic manifestations are transient in many patients with the syndrome. Provocation tests with sodium channel blockers are often required to unmask ECG abnormalities in Brugada syndrome. We aimed to establish sensitivity, specificity, and safety of propafenone testing using ajmaline testing for control. Methods: The effect of intravenous ajmaline (1 mg/kg over 5 min) and propafenone (1 mg/kg over 5 min) on the ECG was studied in 14 patients with who had Brugada Syndrome suspicions. The test was considered positive if the abnormal coved-type ECG pattern appeared in more than one right precordial lead (V1–V3).