SPC365

Ajmaline testing in Brugada Syndrome: a comparative analysis of diagnostic protocols and clinical outcomes across two hospitals

Session: Sessão de Posters 19 - Genética em Cardiologia 1
Speaker: Cátia Oliveira

Congress: CPC 2024
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 20. Congenital Heart Disease and Pediatric Cardiology
Subtheme: 20.6 Congenital Heart Disease – Clinical
Session Type: Cartazes
FP Number: ---
Authors: Cátia Oliveira; Mariana Tinoco; Ana Pinho; Luís Santos; Lucy Calvo; João Calvão; Ricardo Pinto; Gonçalo Pestana; Marta Madeira; Rui André Rodrigues; Luís Adão; Ana Lebreiro

<p style="text-align:justify"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Introduction: </span></strong><span style="font-family:&quot;Arial&quot;,sans-serif">The diagnosis of Brugada Syndrome (BS) requires the presence of a type 1 Brugada pattern (BrP1) on an ECG, either spontaneously or induced through a provocative test using a sodium channel blocker. </span><span style="font-family:&quot;Arial&quot;,sans-serif">However, variations in protocols and management strategies exist across different medical centers.</span></span></span></span></p>

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<p style="text-align:justify"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Aim:</span></strong><span style="font-family:&quot;Arial&quot;,sans-serif"> To characterize two groups of patients (pts) referred for ajmaline test (AT) in two </span><span style="font-family:&quot;Arial&quot;,sans-serif">distinct hospitals, evaluating patient baseline features, test protocols, and outcomes</span><span style="font-family:&quot;Arial&quot;,sans-serif">. </span></span></span></span></p>

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<p style="text-align:justify"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Methods:</span></strong> <span style="font-family:&quot;Arial&quot;,sans-serif">We performed a retrospective and observational analysis of adult pts who underwent AT between March 2020 and June 2023. One hospital (group A) used an infusion protocol and the other a bolus protocol (group B). Interruption criteria of tests were a positive result or the occurrence of any complications as described in the ESC guidelines.</span></span></span></span></p>

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<p style="text-align:justify"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Results:&nbsp;</span></strong></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial&quot;,sans-serif">A total of 101 pts were included with a mean age of 45.6&plusmn;15.5 years-old, most were males (59.4%); 49 pts were included in group A and 52 pts in group B. While the groups were similar in age, group A had a higher proportion of male pts (73.5% vs 46.2%, p=0.005).</span></span></span></span></p>

<p style="text-align:justify"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial&quot;,sans-serif">In general, the most frequent indications for performing an AT was family screening (45.5%), type 2 Brugada pattern (BrP2) (33.7%), BrP2 and SCD/BS family history (6.9%) and syncope (4%). The majority of pts were asymptomatic in both groups (73.5% vs 76.4%, p=0.26). </span></span></span></span></p>

<p style="text-align:justify"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial&quot;,sans-serif">Overall, 57.4% of tests were positive, with Group A demonstrating a significantly higher rate of positive results than group B (69.4% vs 46.2%, p=0.018). Most pts in group A were referred due to a baseline ECG with BrP2 (group A: 55.1% vs group B: 26.9%, p=0.004), while in group B, most tests were performed for family screening ( group A: 22.4% vs group B: 73.1%, p=0.004). Group-specific analyses revealed that positive tests in group B were often associated with a suspicious baseline ECG (76.9% of pts with a&nbsp;positive test&nbsp;had a BrP2 in their baseline ECG), suggesting its influence on test outcomes. &nbsp;No complications requiring test interruption were observed.</span></span></span></span></p>

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<p style="text-align:justify"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Conclusion:&nbsp;</span></strong></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="font-family:&quot;Arial&quot;,sans-serif">Consistent with previous studies, BrS was diagnosed in a significant proportion of patients that underwent ajmaline testing across diverse clinical scenarios. Also in line with former published results, a BrP2 in patients&#39; baseline ECG was more prevalent in pts with a positive response. </span></span><span style="font-family:&quot;Arial&quot;,sans-serif">This study </span><span style="font-family:&quot;Arial&quot;,sans-serif">emphasizes the need for larger investigations to establish standardized indications and protocols for ajmaline testing in BrS diagnosis. Our findings contribute to the ongoing effort to enhance uniformity in clinical practices related to Brugada Syndrome.</span></span></span></span></p>