Ventricular Tachycardia During Ajmaline Challenge

We report the case of a 63 year old woman who comes to an ajmaline challenged. After 8 minutes of infusion her baseline ECG showed significant QRS complex prolongation and switched over to the typical coved-type ECG. Subsequently a sustained monomorphic ventricular tachycardia was developed, followed by a sustained polymorphyc VT onset, which finally degenerated in a hemodynamically non relevant sustained monomorphic VT. Finally, a 200J defibrillation was required to terminate the arrythmia. Sustained ventricular arrhytmia (SVA) is infrequent but not an exceptional event (0.1-18%) and ajmaline is considered a valuable drug. In addition, provocation testing must be performed in an appropiate environment with advanced life support facilities. The evidence shows that the occurrence of ajmaline-induced sustained ventricular arryhtmia in patients with BS might not identify a category at higher risk for further arrhythmic events during follow-up.