What is Brugada syndrome?
Brugada syndrome is a rare but serious condition that affects the way the electrical signals pass through the heart. It can cause the heart to beat dangerously fast. These unusually fast heart beats are known as an arrhythmia and can sometimes be life-threatening.
If the ventricles (bottom chambers of the heart) start beating at an abnormally fast rate this may result in the heart not working as efficiently, which can cause symptoms such as weakness, dizziness, chest pain, shortness of breath or even collapse. However, it is important to remember that the majority of patients who have the Brugada appearance on their electrocardiogram (ECG) do not experience an arrhythmia and feel perfectly well.
An ECG is a simple and useful test which records the rhythm, rate and electrical activity of your heart.
Brugada syndrome is usually caused by a faulty gene that is inherited by a child from a parent. If you have a close family member either diagnosed with the condition or who has died young, it is very important that all remaining relatives are screened for the Brugada syndrome. You should discuss this with your GP or cardiologist.
Why do I need an ajmaline challenge?
Your doctor has advised you to undergo an ajmaline challenge to exclude Brugada syndrome. An ajmaline challenge is a well-established clinical test, the purpose of which is to see if you are likely to have Brugada syndrome.
What is an ajmaline challenge?
Ajmaline is a drug which will show up ECG changes if you have Brugada syndrome. In patients with normal heart cells, ajmaline has little or no effect on the ECG.
The actual test will take approximately 10 minutes. The doctor will administer the drug through a small tube (cannula) inserted into a vein in your hand or arm and record intermittent ECGs. ECGs record the electrical signals (activity) from inside your heart. The ECG will record how your heart reacts to ajmaline, which allows your doctor to collect any relevant information.
Before the procedure
On your arrival to the ward, you will be introduced to the nurse who will be looking after you. A specialist nurse and doctor will talk to you and your family about your procedure and answer any questions you may have.
Before the test you will have an ECG recorded. The doctor will explain the test to you, and they will then ask you to sign a consent form; this is to ensure you understand the test and its associated risks. If you have any worries or questions, please do not be afraid to ask.
It is important to tell your nurse or doctor if you have any allergies or have had a previous reaction to drugs or any other tests.
A nurse will help to get you ready and you will have a small tube (cannula) inserted into a vein in your hand or arm. This is to allow the ajmaline drug to be given during the test. You may be given a hospital gown to wear, making it easier to record the ECG during the test.
Risks of the procedure
Complications associated with this test are very rare. However, it is important that you are aware that on rare occasions there are some risks associated with this test. The risks are outlined below, can be treated and are rarely life threatening.
- During the test it is common to experience a metallic taste in your mouth.
- You may also experience a visual disturbance such as double vision; both will resolve once the infusion is stopped.
- Other potential side effects include flushing, nausea and headache. Such side effects usually resolve quickly once the test is completed.
- Very rarely, in less than 1% of patients, the ajmaline may cause your heart to go into a very fast heart rhythm; if this happens the doctor may need to correct your arrhythmia quickly by Cardioversion. Cardioversion is a well-established and effective treatment for fast heart rhythms. Before you are cardioverted you may be given a short-acting sedative to make you sleepy. Once you are asleep a machine called a defibrillator is used to send electrical energy to the heart muscle to restore the heart back to a normal heart rhythm.
After the procedure
Once the test is complete your ECG will be recorded for up to an hour at varying intervals. By this time 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 will have returned to normal. You will then be given a drink and something to eat and the cannula will be removed. You should be able to go home shortly after that.
If you have had to be cardioverted you will need to be monitored for a longer period of time but if you remain stable, you should be able to go home later that day. It is advisable that you do not drive to this appointment.
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.