Arrhythmias & electrophysiology
Safety, Utility, and Outcomes of Procainamide Challenge for the Diagnosis and Exclusion of Brugada Syndrome
Authors' conclusion
Procainamide infusion is extremely safe for the diagnosis and exclusion of Brugada syndrome, with yield dependent on pretest probability and indication for testing. Estimated sensitivity and specificity appear to be high. Patients with an asymptomatic procainamide-induced type 1 Brugada pattern are at very low risk of malignant ventricular arrhythmias.
Study context
- Population
- Consecutive patients undergoing procainamide infusion for diagnosis or exclusion of Brugada syndromeunderwent procainamide infusion
- Participants
- 947 patients
- Exposure
- Procainamide-induced type 1 Brugada pattern vs spontaneous type 1 pattern
- Procainamide-induced type 1n = 137
- Spontaneous type 1n = 105reference
- Outcome
- Composite arrhythmic end point
Methodological detailsconsecutive patients, Canadian Hearts in Rhythm Organization registry
- Consecutive patients
- Canadian Hearts in Rhythm Organization registry
Main finding
As reported in the abstract
Primary composite arrhythmic end point
Observational data: associations, not effects.
Further findings
Yield of type 1 pattern by indication
- Unexplained cardiac arrest (n=390)
- 7.2%
- Family history of Brugada syndrome (n=135)
- 22.2%
- Family history of unexplained cardiac arrest or sudden death (n=116)
- 6.9%
- Non-specific type 2 or 3 Brugada pattern (n=189)
- 46.6%
- Intermittent spontaneous type 1 pattern (implied sensitivity)
- 92%
- Estimated specificity very high
ICD in procainamide-induced type 1
- Primary prevention ICD at baseline (one appropriate shock)
- 13%
- ICD implanted during follow-up, mainly for syncope with suspected arrhythmic mechanism
- 7%
- Appropriate therapy after ICD implanted during follow-up
- 0
Safety
| Outcome | Values |
|---|---|
| Asymptomatic ventricular arrhythmias related to procainamideResolved upon discontinuation of the infusion | Procainamide infusion 0.2% |
Original publication
Safety, Utility, and Outcomes of Procainamide Challenge for the Diagnosis and Exclusion of Brugada Syndrome. Circulation. Published 4 December 2025. doi:10.
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