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Table 6 Intravenous provocative diagnostic tests Diagnostic test Indication Protocols Dose/infusion rate/duration Positive test Contraindications Criteria to stop test, counselling and management Observation times Location Ref Ajmaline Family history of BrS or SADS. Resuscitated CA without SHD. 1 mg/kg over 5–10 min (maximum dose 100 mg) or 1 mg/kg at 10 mg/min. Record in standard and high precordial leads over 30 min. BrS type 1 ECG. Type I BrS ECG, HF. Precaution if evidence of conduction disease (consider temporary pacing wire). VT/VF, Type 1 BrS ECG, PVCs, QRS widening .150%. If VT/VF, administer iv isoprenaline, iv sodium bicarbonate. 30 min if negative test; 4 h if positive test. Cath lab or outpatient testing location with full resuscitation equipment. 136,138,139 Flecainide Same as ajmaline. 2 mg/kg over 10 min (maximum dose 150 mg). Record in standard and high precordial leads over 30 min. Same as ajmaline. Same as ajmaline. Same as ajmaline. 4 h if negative test; 24 h if positive test. Same as ajmaline. 140 Epinephrine CPVT and resuscitated CA with or without SHD when exercise test not feasible. Family history of SADS. Rest 10 min. Start at 0.025 μg/ kg/ min for 10 min increase sequentially to 0.05, 0.1 and 0.2 μg/ kg/min in 5 min steps. ≥3 beats of PVT or bidirectional VT. QTc prolongation ≥480 ms. Systolic blood pressure ≥ 200 mmHg, non-sustained VT or PVT, .10 PVCs /min, T-wave alternans, or patient intolerance. If symptoms persist after discontinuation, iv metoprolol 2.5–5 mg over 1 min. 30 min. Same as ajmaline. 141 Acetylcholine Suspicion of coronary vasospasm. Intracoronary injection: RCA: 20 and 50 μg. LCA: 20, 50, and 100 μg over 20 s. .3-min intervals between injections. Maximal dose of 50 μg in the RCA and 100 μg in the LCA. Coronary artery spasm visualized during procedure. Left main stenosis .50%, 3-vessel disease, 2-vessel disease with total occlusion, NYHA III/IV HF, renal failure, severe bronchial asthma. Temporary wire for back-up pacing. Risk of cardiogenic shock. Normal post-procedure observational time. Cath lab. 142 Continued Downloaded from academic.oup.com/eurheartj/article/43/40/3997/6675633 by guest on 07 October 2026