Malignant Purkinje ectopy induced by sodium channel blockers.

Abstract

BACKGROUND:

Sodium channel blocker (SCB) infusion is used to unmask the electrocardiographic pattern of Brugada syndrome. The test may also induce premature ventricular complexes (PVCs) in individuals without Brugada pattern, the clinical relevance of which is little known.

OBJECTIVE:

The purpose of this study was to describe the prevalence of short-coupled (Sc) PVCs induced by ajmaline or flecainide in patients with suspected or documented severe ventricular arrhythmias.

METHODS:

We reviewed the SCB tests performed in 335 patients with suspected ventricular arrhythmias and structurally normal hearts in 9 centers. ScPVCs were defined as frequent and repetitive PVCs with an R-on-T pattern on SCB tests. Repeated SCB tests were performed in 7 patients and electrophysiological mapping of ScPVCs in 9.

RESULTS:

Sixteen patients (8 men; mean age 36 ± 11 years) showed ScPVCs and were included. ScPVCs appeared 229 ± 118 seconds after the initiation of infusion and displayed coupling intervals of 288 ± 28 ms. ScPVC patterns were monomorphic in 12 patients, originating from the Purkinje system in mapped patients. Repetitive PVCs were induced in 15 patients (94%) including polymorphic ventricular tachycardias in 9 (56%). SCB infusion was repeated 45 (interquartile range 0.6-46) months later and induced identical ScPVC in all. SCB test was the only mean to reveal the malignant arrhythmia in 6 patients. Catheter ablation was performed in 9 patients, resulting in arrhythmia elimination in 8 with a follow-up of 6 (interquartile range 2-9) years.

CONCLUSION:

SCB can induce ScPVC, mostly from Purkinje tissue, in a small subset of patients with idiopathic ventricular arrhythmias. Its high reproducibility suggests a distinct individual mechanism.

• Authors: William Escande, Jean-Baptiste Gourraud, Michel Haissaguerre, Estelle Gandjbakhch, Thomas Lavergne, Raphael Martins, Ghassen Cheniti, Philipp Krisai, Jean Sylvain Hermida, Philippe Maury, Jose-Louis Merino, Jean-Luc Pasquié, Nicolas Combes, Elodie Surget, Josselin Duchateau, Thomas Pambrun, Nicolas Derval, Mélèze Hocini, Pierre Jaïs, Pieter G Postema, Koonlawee Nademanee, Ed Vigmond, Olivier Bernus, Frederic Sacher, Vincent Probst
• Journal: Heart rhythm (Heart Rhythm) Vol. 19 Issue 10 Pg. 1595-1603 (10 2022) ISSN: 1556-3871 [Electronic] United States
• PMID: 35835363 (Publication Type: Journal Article, Review, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2022 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Chemical References

• Sodium Channel Blockers
• Ajmaline
• Flecainide

Topics

• Adult
• Ajmaline
• Catheter Ablation
• Electrocardiography (methods)
• Flecainide
• Humans
• Male
• Middle Aged
• Reproducibility of Results
• Sodium Channel Blockers (adverse effects)
• Tachycardia, Ventricular (diagnosis, epidemiology, etiology)
• Ventricular Premature Complexes