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Brugada syndrome (BS) is an inheritable syndrome characterised by coved-type ST segment elevation in the right precordial leads (V1–V3) and increased risk of sudden death in the absence of structural heart disease.1 Intravenous administration of class IC antiarrhythmic drugs is an established tool to unmask the diagnostic Brugada ECG pattern in patients with suspected BS and non-diagnostic ECG.2 Current data indicate that ajmaline is the most effective drug for the diagnosis of BS, mainly because of its kinetics and strength of rate-dependent sodium channel blocking effects.3
McMillan et al report on feasibility and outcomes of ajmaline challenge in children. Ninety-five participants aged 18 years or less (mean age: 12.5±3.3 years) underwent ajmaline challenge for suspected BS4. Forty-eight per cent of them were BS family members. Ajmaline unmasked diagnostic Brugada type I ECG in 20% of individuals. Drug infusion was discontinued in all patients before reaching the target dose in case of appearance of diagnostic Brugada …