| Title |
Yield and Pitfalls of Ajmaline Testing in the Evaluation of Unexplained Cardiac Arrest and Sudden Unexplained Death Single-Center Experience With 482 Families
|
|---|---|
| Published in |
JACC: Clinical Electrophysiology, June 2017
|
| DOI | 10.1016/j.jacep.2017.04.005 |
| Pubmed ID | |
| Authors |
Rafik Tadros, Eline A. Nannenberg, Krystien V. Lieve, Doris Škorić-Milosavljević, Najim Lahrouchi, Ronald H. Lekanne Deprez, Jeroen Vendrik, Yolan J. Reckman, Pieter G. Postema, Ahmad S. Amin, Connie R. Bezzina, Arthur A.M. Wilde, Hanno L. Tan |
| Abstract |
This study evaluated the yield of ajmaline testing and assessed the occurrence of confounding responses in a large cohort of families with unexplained cardiac arrest (UCA) or sudden unexplained death (SUD). Ajmaline testing to diagnose Brugada syndrome (BrS) is routinely used in the evaluation of SUD and UCA, but its yield, limitations, and appropriate dosing have not been studied in a large cohort. We assessed ajmaline test response and genetic testing results in 637 individuals from 482 families who underwent ajmaline testing for SUD or UCA. Overall, 89 individuals (14%) from 88 families (18%) had a positive ajmaline test result. SCN5A mutations were identified in 9 of 86 ajmaline-positive cases (10%). SCN5A mutation carriers had positive test results at significantly lower ajmaline doses than noncarriers (0.75 [range: 0.64 to 0.98] mg/kg vs. 1.03 [range: 0.95 to 1.14] mg/kg, respectively; p < 0.01). In 7 of 88 families (8%), it was concluded that the positive ajmaline response was a confounder, either in the presence of an alternative genetic diagnosis accounting for UCA/SUD (5 cases) or noncosegregation of positive ajmaline response and arrhythmia (2 cases). The rate of confounding responses was significantly higher in positive ajmaline responses obtained at >1 mg/kg than in those obtained at ≤1 mg/kg (7 of 48 vs. 0 of 41 individuals; Fisher's exact test: p = 0.014). In line with previous, smaller studies, a positive ajmaline response was observed in a large proportion of UCA/SUD families. Importantly, our data emphasize the potential for confounding possibly false-positive ajmaline responses in this population, particularly at high doses, which could possibly lead to a misdiagnosis. Clinicians should consider all alternative causes in UCA/SUD and avoid ajmaline doses >1 mg/kg. |
X Demographics
The data shown below were collected from the profiles of 7 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Spain | 2 | 29% |
| Canada | 1 | 14% |
| Djibouti | 1 | 14% |
| United States | 1 | 14% |
| Unknown | 2 | 29% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 4 | 57% |
| Practitioners (doctors, other healthcare professionals) | 2 | 29% |
| Science communicators (journalists, bloggers, editors) | 1 | 14% |
Mendeley readers
The data shown below were compiled from readership statistics for 46 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 46 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 9 | 20% |
| Student > Ph. D. Student | 5 | 11% |
| Student > Postgraduate | 4 | 9% |
| Student > Doctoral Student | 3 | 7% |
| Other | 3 | 7% |
| Other | 6 | 13% |
| Unknown | 16 | 35% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 19 | 41% |
| Biochemistry, Genetics and Molecular Biology | 1 | 2% |
| Agricultural and Biological Sciences | 1 | 2% |
| Nursing and Health Professions | 1 | 2% |
| Computer Science | 1 | 2% |
| Other | 1 | 2% |
| Unknown | 22 | 48% |
Attention Score in Context
This research output has an Altmetric Attention Score of 5. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 27 July 2019.
All research outputs
#7,303,959
of 25,382,440 outputs
Outputs from JACC: Clinical Electrophysiology
#1,098
of 1,554 outputs
Outputs of similar age
#109,031
of 328,389 outputs
Outputs of similar age from JACC: Clinical Electrophysiology
#29
of 40 outputs
Altmetric has tracked 25,382,440 research outputs across all sources so far. This one has received more attention than most of these and is in the 71st percentile.
So far Altmetric has tracked 1,554 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 20.9. This one is in the 29th percentile – i.e., 29% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 328,389 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 66% of its contemporaries.
We're also able to compare this research output to 40 others from the same source and published within six weeks on either side of this one. This one is in the 27th percentile – i.e., 27% of its contemporaries scored the same or lower than it.