Efficacy of Propafenone When Used in Combination Antiarrhythmic Therapy

Propafenone is a new antiarrhythmic agent that has been classified as a type IC agent. Combination therapy using propafenone with either procainamide or quinidine was undertaken in this study. The addition of propafenone to procainamide or quinidine in 30 patients with more than 30 VPDs per hour resulted in a mean suppression of VPD frequency of 80%; 8 of 11 patients with runs of ventricular tachycardia had greater than 90% reduction of these events during combination therapy. During combination therapy, only two patients had proarrhythmic effects. Thus, this study demonstrates that combination of propafenone with either quinidine or procainamide is effective in suppressing ventricular arrhythmias.     

Propafenone Therapy in Patients with Serious Ventricular Arrhythmia - Noninvasive Evaluation of Efficacy

Propafenone is a newv IC antiarrhythmic agent that is effective for suppression of spontaneously occurring ventricular arrhythmia as evauated with monitoring and exercise testing. The incidence of nonserious, but disturbing side effects is low and the drug infrequently is discontinued because of adverse reactions. Serious side effects are primarily cardiac and include arrhythmia aggravation, CHF exacerbation, and conduction abnormalities. These complications occur primarily in those with severe underlying heart disease in whom this drug, like other antiarrhythmic agents, must be used cautiously. If the drug is effective and well tolerated, arrhythmia recurrence can be prevented.     

Hemodynamic Effect of Propafenone and the Experience in Patients with Congestive Heart Failure

The effects of propafenone on left ventricular function and hemodynamics are presented in this study. In one group of 13 patients who underwent electrophysiological testing and subsequent chronic oral therapy with propafenone, eight had left ventricular ejection fractions determined by nuclear study before and during therapy with the drug. Initial measurements ranged from 22% to 39% (mean 30%), while those on chronic therapy showed no statistical difference and ranged from 22% to 48% (mean 30%). In a separate dose titration study of 14 patients, left ventricular ejection fraction showed a modest but significant decrease (52%± 9% to 48%± 11%; p < 0.05). This change was more marked in patients with an initial low ejection fraction. Propafenone appears to be safe in these patients but should be administered with caution in patients with particularly low ejection fractions.     

Comparative Investigation of the Antiarrhythmic Effect of Propafenone (Rytmonorm) and Lidocaine in Patients with Ventricular Arrhythmias during Acute Myocardial Infarction

ABSTRACT Propafenone, a new class I antiarrhythmic drug, given as a bolus injection followed by oral medication, or lidocaine were given to 20 consecutive patients admitted with chest pain suggesting acute myocardial infarction and showing high grades, i.e. multiform, pairs or R-on-T premature ventricular complexes or short runs of ventricular tachycardia. Before institution of therapy the mean number (±1 SD) of premature ventricular contractions (PVCs) per hour was 169±123 in the lidocaine group and 324±440 in the propafenone group. During the next 24 hours lidocaine reduced the numbers of PVCs by 73% and propafenone by 75%. The mean number (±1 SD) of 5-minute periods with high grade PVCs was 4.3±2.9 in the lidocaine group and 5.8±4.5 in the propafenone group. During therapy this number was equally reduced in both groups to 2.4. One patient in the lidocaine group developed ventricular fibrillation and three patients in the propafenone group were excluded because of increasing numbers of PVCs. One patient in the propafenone group showed a torsade-de-pointes ventricular tachycardia.     

Role of Propafenone in the Treatment of Ventricular Premature Beats

The effectiveness of propafenone versus quinidine for the therapy of ventricular premature beats was evaluated in a placebo-controlled double-blind parallel study. A total of 105 patients was entered; 53 patients were randomly assigned to receive propafenone (600 mg/day and 900 mg/day during low-and high-dose weeks, respectively) and 52 patients were randomly assigned to receive quinidine (800 mg/day and 1,600 mg/day, respectively). Both drugs significantly reduced ventricular ectopy at both dose levels; there was no statistically significant difference between the two drugs in effectiveness, although a higher percentage of patients responded to propafenone. Side effects resulting in discontinuation of therapy were more common with quinidine. This study confirms the effectiveness of propafenone in the therapy of ventricular premature beats.     

Propafenone versus Disopyramide for Treatment of Chronic Symptomatic Ventricular Arrhythmias

ABSTRACT The efficacy and safety of propafenone, 150 mg four times daily, were compared with those of disopyramide, 100 mg four times daily, in a randomized single-blind, cross-over study in 38 patients with symptomatic premature ventricular complexes (PVCs). The 24-hour ambulatory ECG, employed for assessing antiarrhythmic efficacy, was analyzed blindly. The median reduction in the number of PVCs was higher with propafenone than with disopyramide (91.4% vs. 63.5%, respectively, p<0.01). A reduction of at least 80% was achieved by propafenone in 22 (59%) and by disopyramide in 16 patients (43%) (NS). Ventricular tachycardias (VTs) were abolished by propafenone in eight out of 11, and by disopyramide in five out of nine patients with VTs (NS) A possible proarrhythmic effect was seen in three patients during disopyramide and in one patient during propafenone treatment. Micturition disturbances (p<0.001) and a dry mouth (p<0.01) were more commonly associated with disopyramide than with propafenone. In conclusion, in the given dosages, propafenone was superior to disopyramide in suppressing PVCs and had fewer side-effects.     

Drug Interactions with Propafenone

Propafenone is a Class IC antiarrhythmic drug that has been under investigation for over 10 years and is on the threshold of release for general use. Clinical trials have been completed that present compelling evidence of the safety and efficacy of the drug for the treatment of malignant ventricular arrhythmias. As with other potent antiarrhythmic agents, propafenone has the propensity to interact with a variety of other drugs, and these interactions are of critical importance to physicians who will prescribe the drug to patients with cardiac arrhythmias. A particularly detailed knowledge of the interactions between propafenone and such commonly used drugs as anticoagulants, digoxin, cimetidine, other antiarrhythmics, and even food is essential to its safe administration. This paper reviews current information regarding the drug interactions of propafenone so that, once released and available, it will be used appropriately and safely.     

心律失常与心脏再同步化治疗无反应性的相关性

虽然基于肾素-血管紧张素-醛固酮抑制剂、β受体阻滞剂的药物治疗使心力衰竭治疗取得了很大进展,但心力衰竭患者的发病率及病死率仍居高不下.心脏再同步化治疗是近年心力衰竭非药物治疗上的重大进展.但是研究表明心脏再同步化治疗后,仍有约30%的心力衰竭患者对心脏再同步化无反应.现综述了心脏再同步化治疗无反应与心律失常之间的关系,并简要讨论对心脏再同步化治疗无反应的可能机制及预防策略.     

Propafenone—Clinical Electrophysiology and Efficacy in Patients with Documented or Potentially Life-threatening Arrhythmias

Propafenone is a new antiarrhythmic agent that inhibits the fast sodium channel and decreases phase 0 of the cardiac action potential. Since it has relatively little effect on the action potential duration, it has been classified as a type IC agent. Propafenone prolongs electrocardiographic intervals including PR and QRS. In addition, atrial and ventricular refractory periods generally are lengthened. Initial reports suggest a favorable effect on suppressing conduction over accessory pathways. Propafenone has been shown to have effectiveness in suppressing life-threatening ventricular arrhythmias as well. Electrophysiological testing is useful, but data such as mode of induction and rate of induced tachycardia should be considered in addition to inducibility status.     

益心舒胶囊联合普罗帕酮治疗室性早搏136例

目的观察益心舒胶囊联合普罗帕酮治疗室性早搏的临床疗效。方法将204例室性早搏患者按照2∶1随机分为治疗组(136例)与对照组(68例)。治疗组口服普罗帕酮与益心舒胶囊,对照组口服普罗帕酮。观察治疗前及治疗4周后两组临床症状、常规12导联心电图、24h动态心电图等变化情况。结果用药后室性早搏总有效率88.97%,临床症状缓解率为91.18%;对照组分别为75.00%、76.47%,两组比较有统计学意义(P<0.05)。结论益心舒胶囊联合普罗帕酮治疗室性早搏较单独使用普罗帕酮疗效显著,且避免了普罗帕酮用量过大引起心律失常等不适。     

T波电交替预测心力衰竭病人心源性猝死价值的新分歧

有半数的心力衰竭病AN致命性室性心律失常事件死于心源性猝死。T波电交替是公认的预测心源性猝死的重要指标。早在许多年前就发现T波电交替与心源性猝死有关,近年来新建了频域和时域测量方法。跨室壁复极离散度异常增大是T波电交替的机制。最近研究发布的用微伏级T波电交替进行心肌梗死后危险性分层的初步结果否定心肌梗死后左室射血分数〈30％的病人发生致死性快速室性心律失常的价值。但体内除颤器置入前T波电交替的对心源性猝死一级预防试验和非缺血性心肌病心力衰竭T波电交替的预测价值试验则强有力地支持T波电交替能预测心律失常。     

Usefulness of Nonlinear Analysis of ECG Signals for Prediction of Inducibility of Sustained Ventricular Tachycardia by Programmed Ventricular Stimulation in Patients with Complex Spontaneous Ventricular Arrhythmias

Introduction : The aim of our study was to assess the effectiveness of the nonlinear analysis (NLA) of ECG in predicting the results of invasive electrophysiologic study (EPS) in patients with ventricular arrhythmias. Methods : We evaluated 25 patients with history of cardiac arrest, syncope, sustained, or nonsustained ventricular tachycardia (VT). All patients underwent electrophysiologic study (EPS) and nonlinear analysis (NLA) of ECG. The study group was compared with a control group of 25 healthy subjects, in order to define the normal range of NLA. ECG was processed in order to obtain numerical values, which were analyzed by nonlinear mathematical functions. Patients were classified through the application of a clustering procedure to the whole set of functions, and the correlation between the results of nonlinear analysis of ECG and EPS was tested. Results : NLA assigned all patients with negative EPS to the same class of healthy subjects, whereas the patients in whom VT was inducible had been correctly and clearly isolated into a separate cluster. In our study, the result of NLA with application of the clustering technique was significantly correlated to that of EPS (P < 0.001), and was able to predict the result of EPS, with a negative predictive value of 100% and a positive predictive value of 100%. Conclusions : NLA can predict the results of EPS with good negative and positive predictive value. However, further studies are needed in order to verify the usefulness of this noninvasive tool for sudden death risk stratification in patients with ventricular arrhythmias.     

Ventricular Tachycardia in Patients with Impaired Left Ventricular Function: The Role of Propafenone

The combined occurrence of left ventricular dysfunction and -ventricular tachyarrhythmias portends a high annual mortality. Anti arrhythmic drugs can ameliorate ventricular arrhythmia and may reduce the risk of sudden cardiac death. We administered propafenone to 15 patients with ventricular tachyarrhythmias and left ventricular ejection fractions 40%. Propafenone significantly reduced isolated ventricular premature depolarizations, couplets, and ventricular tachycardia on ambulatory monitoring. Propafenone eliminated all exercise provocable ventricular tachycardia. Propafenone additionally abolished ventricular tachycardia inducible by programmed stimulation in 4 of 7 patients. In 8 patients studied before and during therapy, there was no significant change in left ventricular ejection fraction as determined by nuclear ventriculography. Propafenone was discontinued in 4 patients due to side effects. Seven patients receiving continuing propafenone therapy remain alive with only one patient suffering arrhythmia recurrence. Propafenone is an effective drug for the management of ventricular tachyarrhythmias and may be used for patients with impaired left ventricular function.     

心脏再同步化治疗与室性心律失常关系研究进展

心脏再同步化治疗可提高心力衰竭患者的运动耐力及纽约心功能分级,但心脏性猝死发生率在再同步化治疗患者中仍很高.有研究提示心脏再同步化治疗中左心室起搏可能通过逆转正常激动顺序、延长QT间期和增加全室壁复极离散度引起恶性室性心律失常的发生,对适合心脏再同步化治疗的患者应评估恶性室性心律失常发生风险,明确是否同时植入带除颤功能的心室电极.     

Incidence of complex ventricular arrhythmias in asymptomatic patients with recent myocardial infarction

The incidence of ventricular extrasystoles (VES) was documented in 50 patients with recent uncomplicated myocardial infarction, with a 72-h two-channel ambulatory electrocardiogram. All patients were free of symptoms of arrhythmias; unstable angina pectoris and heart failure were absent. A total of 82% of the patients had VES: 23/50 patients had multiform or complex VES, 8/50 patients had ventricular tachycardia. VES were independent of heart rate and stable angina pectoris. Thus, frequent and complex VES are common in asymptomatic patients with uncomplicated recent myocardial infarction. Even in the absence of symptoms, ambulatory electrocardiography is useful. The prognostic significance of asymptomatic complex VES in these patients remains unsettled.