Propafenone in the conversion of atrial fibrillation in patients suffering from chronic renal failure.

Propafenone is a class Ic agent for the treatment of atrial arrhythmias with a main hepatic metabolism. This approach might play an important role in the management of atrial arrhythmias in patients with chronic renal failure. The goal of this study was to investigate the effects of propafenone in patients with atrial fibrillation and chronic renal failure. We studied 24 patients with atrial fibrillation that was associated with chronic renal failure. The conversion time was 8.4 +/- 3.2 minutes (range, 5-19 minutes) with intravenous propafenone at 1 mg/kg bolus over 5 minutes. In 21 patients (87%) sinus rhythm was restored and no serious adverse and proarrhythmic effects were noted. Corrected QT interval was not prolonged after conversion (from 0.33+/-0.06 mm to 0.32+/-0.04 mm, p = not significant). Two and 6 months later the cardioversion left atrial size significantly decreased in 19 patients who had been converted to sinus rhythm. The parameters of renal function were unchanged after propafenone therapy. We concluded that: 1) propafenone is active and acts significantly faster in converting atrial fibrillation in patients with chronic renal insufficiency; 2) propafenone administration appears to be safe in patients with chronic renal failure; and 3) left atrial size decreases upon conversion to sinus rhythm as seen at 6-month follow-up.