Malignant Ventricular Tachycardia During Propafenone Treatment in a Child with Junctional Automatic Tachycardia: Effectiveness of Intravenous Molar Sodium Lactate |
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Authors: | PATRICE SCANU GILLES GROLLIER DANIELE GUILLEMAN MICHEL ISELIN PIERRE BUSTANY JEAN-MICHEL HURPE JEAN-CLAUDE PC-TIER |
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Affiliation: | Cardiology Intensive Care Unit, University of Caen School of Medicine, Caen, France;Department of Clinical Pharmacology, University of Caen School of Medicine, Caen, France;Department of Emergency Cares, University of Caen School of Medicine, Caen, France |
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Abstract: | Propafenone may aggravate the preexisting arrhythmia or induce another one. Usually, such proarrhythmic effects occur in patients with spontaneous ventricular arrhythmias and/or coronary heart disease with poor left ventricular function. We report the case of a 5-year-old girl with Junctional automatic tachycardia and no structural heart disease, in whom malignant ventricular tachycardia occurring during propafenone treatment could be terminated by molar sodium lactate (MSL) infusion. The serum propafenone level obtained before MSL infusion was within the therapeutic range. Two hypothesis could explain the beneficial effects of MSL in our patient: (1) alkalinization facilitates the cell membrane hyperpolarization and thus can decrease the voltage-dependent effect of Class Ic drugs, (2) alkalinization could displace propafenone from its tissue receptor sites by an increase in the nonionized fraction. |
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Keywords: | proarrhythmic effects propafenone automatic Junctional tachycardia alkalinization Class Ic agents |
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