The diagnostic role of pharmacological provocation testing in cardiac electrophysiology: a clinical consensus statement of the European Heart Rhythm Association and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC, the ESC Working Group on Cardiovascular Pharmacotherapy, the Association of European Paediatric and Congenital Cardiology (AEPC), the Paediatric & Congenital Electrophysiology Society (PACES), the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS)
Behr, Elijah R Winkel, Bo Gregers Ensam, Bode Alfie, Alberto Arbelo, Elena Berry, Colin Cerrone, Marina Conte, Giulio Crotti, Lia Corcia, Cecilia M Gonzalez
Behr, Elijah R
Winkel, Bo Gregers
Ensam, Bode
Alfie, Alberto
Arbelo, Elena
Berry, Colin
Cerrone, Marina
Conte, Giulio
Crotti, Lia
Corcia, Cecilia M Gonzalez
Affiliation
University of London; St George's University Hospitals NHS Foundation Trust; Mayo Clinic Healthcare; Copenhagen University Hospital-Rigshospitalet; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart; University Hospitals Birmingham NHS Foundation Trust; Hospital Nacional Profesor Alejandro Posadas; Universitat de Barcelona; Institut d'Investigació August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV); Golden Jubilee National Hospital; New York University; Cardiocentro Ticino Institute Ente Ospedaliero Cantonale; Istituto Auxologico Italiano Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics; Università Milano-Bicocca; Sainte-Justine University Hospital Center; Chulalongkorn University; Amsterdam University Medical Centre; IRCCS Istituti Clinici Scientifici Maugeri; University of Pavia; Nantes Université; Centre Hospitalier Universitaire Nantes; Hospital Sant Joan de Déu; University Hospital Münster; Montreal Heart Institute; University of Copenhagen; Kliniken Ludwigsburg Bietigheim gGmbH; Universidad de la República; Radboud University Medical Center; University Duisburg-Essen; Université de Montréal; Baylor College of Medicine; Bambino Gesù Children's Hospital; Oslo University Hospital; University of Oslo; University of British Columbia; University Medical Center Göttingen; Georg-August-University; Barts Heart Centre; University Hospital Bern; University of Bern; Nippon Medical School; New Tokyo Hospital; Electrophysiology Bremen
Other Contributors
Publication date
2025-04-01
Subject
Collections
Research Projects
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Journal Issue
Abstract
The pharmacological provocation test is a pivotal tool in cardiac electrophysiology for the diagnosis of potential causes of sudden cardiac death, sudden cardiac arrest (SCA), arrhythmias, symptoms, or ECG abnormalities. The 2022 European Society of Cardiology Guidelines for the Treatment of Ventricular Arrhythmias and Prevention of Sudden Cardiac Death offered guidance on provocation testing but did not describe the indications and requirements in depth. This clinical consensus statement, led by the European Heart Rhythm Association and approved by major international stakeholders, aims to advise the general cardiologist and the arrhythmia expert who to test and when, where, and how to do it. The statement focuses on current practice for the diagnosis of subclinical arrhythmia syndromes and the causes of SCA, building upon the recommendations of the Guidelines. We address the sodium channel blocker provocation test for patients suspected of Brugada syndrome as well as the use of epinephrine, isoproterenol, adenosine, ergonovine, and acetylcholine.
Citation
Behr ER, Winkel BG, Ensam B, Alfie A, Arbelo E, Berry C, Cerrone M, Conte G, Crotti L, Corcia CMG, Kaski JC, Nademanee K, Postema PG, Priori S, Probst V, Sarquella-Brugada G, Schulze-Bahr E, Tadros R, Wilde A, Tfelt-Hansen J, Wolpert C, Cuesta A, Damman P, Dobrev D, Drago F, Haugaa K, Krahn A, Krause U, Lambiase PD, Napolitano C, Odening KE, Shimizu W, Veltmann C. The diagnostic role of pharmacological provocation testing in cardiac electrophysiology: a clinical consensus statement of the European Heart Rhythm Association and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC, the ESC Working Group on Cardiovascular Pharmacotherapy, the Association of European Paediatric and Congenital Cardiology (AEPC), the Paediatric & Congenital Electrophysiology Society (PACES), the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS). Europace. 2025 Mar 28;27(4):euaf067. doi: 10.1093/europace/euaf067.
Type
Article