<HTML><BODY style="word-wrap: break-word; -khtml-nbsp-mode: space; -khtml-line-break: after-white-space; "><DIV>Dear Dr Arenzo:</DIV><DIV>In the individual with type I ecg, there is no need for an ajamline test,</DIV><DIV>the diagnosis is made. If the ecg is "type II or III" (non-diagnostic),</DIV><DIV>ajmaline test is recommended.</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV>You will find all the options available in how to deal with the asymptomatic</DIV><DIV>patient with type I ecg.</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV>- follow-up until he develops symptoms.</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV>- ICD implantation, especially if there is a remote possibility of</DIV><DIV>sudden cardiac death in the family</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV>- EPS as tool for risk stratification. A positive non-aggressive</DIV><DIV>EPS is very indicative of a patient with an increased risk for</DIV><DIV>arrhythmogenecity.</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV>A negative EPS in the sporadic individual is indicative of good prognosis. </DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV>As you well know, the use of EPS to risk stratify asymptomatic patients is</DIV><DIV>very controversial. However, the first two options are not perfect. The</DIV><DIV>first symptom may be sudden death, and ICD is not free of collateral</DIV><DIV>problems and certainly not an easy decision for an asymptomatic 40 year old</DIV><DIV>.</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV>Thank you</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV>Ramon Brugada MD FACC</DIV><DIV>Associate Professor of Medicine</DIV><DIV>Canadian Research Chair Genetics of Arrhythmias</DIV><DIV>University of Montreal</DIV><DIV>Director Clinical Cardiovascular Genetics Center</DIV><DIV>Montreal Heart Institute</DIV><DIV>5000 Rue Belanger</DIV><DIV>Montreal, QC H1T 1C8</DIV><DIV>Canada</DIV><DIV><A href="mailto:ramon@brugada.org">ramon@brugada.org</A></DIV><BR><DIV> <SPAN class="Apple-style-span" style="border-collapse: separate; border-spacing: 0px 0px; color: rgb(0, 0, 0); font-family: Helvetica; font-size: 12px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; text-align: auto; -khtml-text-decorations-in-effect: none; text-indent: 0px; -apple-text-size-adjust: auto; text-transform: none; orphans: 2; white-space: normal; widows: 2; word-spacing: 0px; "><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">--</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Dr.<SPAN class="Apple-converted-space"> </SPAN>Sergio<SPAN class="Apple-converted-space"> </SPAN>Dubner</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">President<SPAN class="Apple-converted-space"> </SPAN>of<SPAN class="Apple-converted-space"> </SPAN>Scientific<SPAN class="Apple-converted-space"> </SPAN>Committee</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 13px/normal Lucida Grande; min-height: 16px; ; font-family: Lucida Grande; font-size: 13px; "><BR style="font-family: Lucida Grande; font-size: 13px; "></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Dr.<SPAN class="Apple-converted-space"> </SPAN>Edgardo<SPAN class="Apple-converted-space"> </SPAN>Schapachnik</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">President<SPAN class="Apple-converted-space"> </SPAN>of<SPAN class="Apple-converted-space"> </SPAN>Steering<SPAN class="Apple-converted-space"> </SPAN>Committee</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV><BR class="khtml-block-placeholder"></DIV><BR class="Apple-interchange-newline"></SPAN> </DIV><BR></BODY></HTML>