• Reference Number: HEY1567/2025
• Departments: Cardiology
• Last Updated: 31 May 2025

Introduction

This leaflet has been produced to give you general information about your procedure. 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 caring for you.

What is a an Ajmaline Provocation Study?

The Ajmaline Provocation study is a procedure used to help diagnose or exclude Brugada Syndrome. This is a relatively rare familial disorder characterised by a typical ECG pattern associated with an increased risk of ventricular arrhythmias and sudden death. Ajmaline is a short-acting medication called a sodium channel blocker. It exerts its effect within 2-3 minutes of administration, has a half-life of 5-6 minutes and an elimination half-life of around 90 minutes. The drug is administered via intravenous injection whilst your heart rhythm is monitored continuously. If Brugada syndrome is evident, this will show up changes on your electrocardiogram (ECG). If you have normal cardiac cells it will have little or no effect on the ECG results.

Why do I need an Ajmaline Provocation Study?

You have been referred for this procedure by a Consultant Electrophysiologist or an Inherited Cardiac Conditions Physician.

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 Provocation study 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, a tingling sensation and also experience visual disturbances such as double vision. These are harmless and will usually get better quickly once the infusion has finished given the short elimination half-life of Ajmaline.

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 known as a cardioversion. Worldwide no cases of death have been reported as a result of an Ajmaline Provocation Study.

How do I prepare for the Ajmaline Provocation Study?

Please read this information leaflet. Share the information it contains with your family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this procedure.

You will be required to attend the pre-assessment clinic prior to your admission. On arrival to this appointment you will see a clinical support worker who will take some blood samples, routine swabs for MRSA screening (a type of bacteria responsible for infection) and a tracing of your heart called an Electrocardiogram.

Following this you will see a nurse practitioner who will perform a baseline nursing assessment, explain the procedure and address any questions or concerns you may have before your admission.

Fasting

You may eat a light meal 4 hours before admission and drink water up to 2 hours before admission 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-assessment 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 so that the nurse can advise appropriately.

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 (mobile phone, books, music to listen to etc).

What will happen?

You should report to the Day Case reception in the Cardiology Outpatient Building at the time stated on your admission letter. Once the receptionist has checked you in a nurse will greet you and you 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 the information you were asked at pre-assessment remains the same and your blood pressure, temperature and blood oxygen level will be recorded. You will have a cannula (a small plastic tube) inserted into a vein in 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 itself?

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. You will remain awake for the procedure. ECG measurements will be taken at regular intervals during and after the procedure until the effects of the Ajmaline have worn off.

What happens afterwards?

When the procedure is over, you will return to the ward area for a period of rest (approx. 90 minutes).

You will be placed on a heart monitor to check your heart rhythm for 90 minutes and your blood pressure will also be monitored during this time. You will have a repeat ECG prior to discharge if the test was negative, if the test was positive you may have several ECGs performed at different intervals to ensure any ECG changes have normalised before discharge.

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, any changes to your medication and follow up if required will be discussed with you prior to leaving hospital.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Cardiology Nurse Practitioners on tel: 01482 461526