• Reference Number: HEY1224/2021
• Departments: Cardiology
• Last Updated: 14 May 2021

Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is an Ajmaline Challenge?

The procedure consists of an intravenous injection of a drug called Ajmaline being administered whilst you have your heart rhythm constantly monitored. Ajmaline is a drug which will show up changes on your electrocardiogram (ECG) if you have Brugada syndrome. If you have normal cardiac cells it will have little or no effect on the ECG results.

Why do I need an Ajmaline Challenge?

Your doctor has recommended that you have an Ajmaline Challenge. The purpose of this test is to see if you are likely to have Brugada syndrome, which is a disorder that affects the cells of the heart, causing it to have an altered rhythm (arrhythmia).

If you have Brugada syndrome you may be at risk of developing fast heart rhythms.

If your heart starts beating at an abnormally fast rate then it does not work as efficiently. This can cause symptoms such as weakness, dizziness, chest pain, shortness of breath, collapse, or even death in very rare cases.

If you have a close family member who has either been diagnosed with Brugada syndrome, or who has died at a young age from a suspected heart condition, it is very important that you and your relatives are screened for Brugada syndrome.

It is important to remember that the majority of people who have the appearance of Brugada syndrome on an ECG do not experience arrhythmia and feel perfectly well. If your doctor suspects you may have Brugada syndrome they will have advised you to have this well established, straight forward clinical test to confirm the diagnosis.

Your doctor will only recommend that you have an Ajmaline Challenge if they feel that the benefits outweigh the risks. 

Can there be any complications or risks

Complications associated with the procedure are very rare, can be treated and are rarely life threatening. It is common to experience a metallic taste in your mouth while you are being given the Ajmaline. You may feel flushed and also experience visual disturbances such as double vision. These are harmless and will usually get better quickly once the infusion has finished.

In less than 1% (less than 1 in 100) of cases the Ajmaline may cause your heart to go into a very fast heart rhythm. If this happens you may need a period of cardiac monitoring until the Ajmaline wears off. In very rare cases this fast heart rhythm may need urgently correcting with a controlled electric shock (cardioversion). Worldwide no cases of death have been reported as a result of an Ajmaline Challenge.

How do I prepare for the Ajmaline Challenge?

Pre-admission

You will be required to attend the pre-assessment clinic usually between one and four weeks before your procedure date.  At this appointment you will see a nurse practitioner who will take a full medical history, perform a physical examination and explain the procedure and address any questions or concerns you may have before you are admitted.

Then you will see a nurse who will perform a baseline nursing assessment. This consists of various questions, such as information about your next of kin, how you usually manage at home, any mobility problems or other issues that we may need to be aware of in order to make your admission as safe and comfortable as possible.

You will then see a clinical support worker who will take some blood samples and swabs for MRSA (a type of bacteria responsible for infection) screening.

Before you leave the hospital an electrocardiograph (ECG) will be performed. 

Fasting

You may eat a light meal 4 hours before admission and drink water up to 2 hours then should be nil by mouth (including chewing gum and boiled sweets).

Medication

Some medications may have to be stopped before the procedure. The nurse at your pre-admission appointment will tell you if this is necessary for you. It is very important that you bring all of your current medications or a current prescription with you to any appointment.

What to bring into hospital with you

It is advisable to bring slippers or something similar to allow you to walk around the ward safely and a dressing gown. Spectacles if worn. All medication in its original packaging. Something to pass the time while you wait for and after the procedure (books, knitting, music to listen to etc) 

What will happen?

You should report to the second reception in Cardiology Outpatient Building at the time stated on your admission letter. Once the receptionist has checked you in will be shown to a bed on the day ward and asked to change into a theatre gown and disposable pants.

The nurse who is looking after you for the shift will then check that none of the information you were asked at pre assessment has changed and your blood pressure, temperature and blood oxygen level will be recorded. You will have a cannula (a small plastic tube) inserted into your hand or arm and a safety checklist will be completed. The cannula allows the staff to administer drugs directly into your blood stream and the checklist is to ensure that you are safely transferred into the Cardiac Catheterisation Laboratory (Cath Lab).

Your Consultant will come to see you and explain the procedure and the risks before asking you to sign a consent form.

The nurses on the ward will not be able to give you an exact time for your procedure until the doctor has seen all of their patients and decided upon the order of the list. Sometimes this means that you may have to wait until the afternoon before your procedure will take place so it is advisable to bring something to pass the time whilst you are waiting.

When it is time for your procedure a nurse from the Cath Lab will come to the ward to collect you. They will go through the safety checklist again before accompanying you into the Cath Lab. 

What will happen during the procedure?

You will be taken through to the Cath Lab and made comfortable on the bed. You will then be attached to a heart and blood pressure monitor as well as an ECG machine.

The Ajmaline will be given to you as an intravenous injection through the cannula in your arm. ECG measurements will be taken at regular intervals during and after the procedure until the effects of the Ajmaline have worn off.

What will happen afterwards?

When the procedure is over, you will return to the ward area for a period of rest.

You will be placed on a heart monitor to check your heart rhythm for a few hours and your blood pressure will also be monitored during this time.

You will be offered something to eat and drink and if your test is negative should be able to go home once you feel back to normal.

You should not drive yourself home following the procedure. It is recommended that you do not drive for 24 hours following the procedure.

The result of the study and any changes to your medication will be discussed with you prior to leaving hospital.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.