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)
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.
Author
Behr, Elijah R
Winkel, Bo Gregers
Ensam, Bode
Alfie, Alberto
Arbelo, Elena
Berry, Colin
Cerrone, Marina
Conte, Giulio
Crotti, Lia
Corcia, Cecilia M Gonzalez
Kaski, Juan Carlos
Nademanee, Koonlawee
Postema, Pieter G
Priori, Silvia
Probst, Vincent
Sarquella-Brugada, Georgia
Schulze-Bahr, Eric
Tadros, Rafik
Wilde, Arthur
Tfelt-Hansen, Jacob
Wolpert, Christian
Cuesta, Alejandro
Damman, Peter
Dobrev, Dobromir
Drago, Fabrizio
Haugaa, Kristina
Krahn, Andrew
Krause, Ulrich
Lambiase, Pier D
Napolitano, Carlo
Odening, Katja E
Shimizu, Wataru
Veltmann, Christian
Winkel, Bo Gregers
Ensam, Bode
Alfie, Alberto
Arbelo, Elena
Berry, Colin
Cerrone, Marina
Conte, Giulio
Crotti, Lia
Corcia, Cecilia M Gonzalez
Kaski, Juan Carlos
Nademanee, Koonlawee
Postema, Pieter G
Priori, Silvia
Probst, Vincent
Sarquella-Brugada, Georgia
Schulze-Bahr, Eric
Tadros, Rafik
Wilde, Arthur
Tfelt-Hansen, Jacob
Wolpert, Christian
Cuesta, Alejandro
Damman, Peter
Dobrev, Dobromir
Drago, Fabrizio
Haugaa, Kristina
Krahn, Andrew
Krause, Ulrich
Lambiase, Pier D
Napolitano, Carlo
Odening, Katja E
Shimizu, Wataru
Veltmann, Christian
Date
2025-04-01
Type
Article
Subject
Cardiology, Practice of medicine
Collections
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.
Journal / Source Title
EP Europace
DOI
10.1093/europace/euaf067
PMID
40165484
Publisher
Oxford University Press
Publisher’s URL
https://academic.oup.com/europace