Guidelines for the Use of Propafenone in Treating Supraventricular Arrhythmias

Abstract

Propafenone is a sodium channel blocking agent with a mild beta- and calcium channel-blocking activity. Several controlled and noncomparative studies have documented its efficacy in a variety of supraventricular arrhythmias in both adults and children. Propafenone is comparable with other Vaughan-William class I antiarrhythmic drugs for acute conversion of atrial fibrillation. It is also comparable with other drugs for prevention of recurrences in paroxysmal atrial fibrillation and for maintenance of sinus rhythm following successful cardioversion of chronic atrial fibrillation. Although propafenone is effective in the acute management of junctional reentrant tachycardias, the availability of safer drugs precludes its routine use for these arrhythmias. It may, however, be preferred for the acute management of haemodynamically well tolerated pre-excited atrial fibrillation in patients with the Wolff-Parkinson-White (WPW) syndrome. It also has documented efficacy in the long term therapy of patients with junctional tachycardias, and is a useful first-line drug in the management of arrhythmias in patients with the WPW syndrome, particularly when there is a short anterograde refractory period of the accessory pathway. Noncomparative studies were confirmed good efficacy and tolerability of propafenone in the short and long term management of paediatric supraventricular arrhythmias. It seems to be particularly effective for the treatment of ectopic atrial and junctional tachycardias, which are generally difficult arrhythmias to manage. Propafenone appears to have an acceptable adverse effect profile during both short and long term therapy. As with most other antiarrhythmic agents, there is a proarrhythmic potential. This has also been observed in children. There is a theoretical possibility that the beta-blocking properties of propafenone may protect against its proarrhythmic potential. However, this has not been confirmed in clinical studies. In conclusion, propafenone appears to be effective in the management of a wide spectrum of supraventricular arrhythmias. It should be considered among the first line drugs for management of these arrhythmias in patients without structural heart disease.

Propafenone for the Prevention of Atrial Tachyarrhythmias After Cardiac Surgery: A Randomized, Double-blind Placebo-controlled Trial

“…10,11 Propafenone is effective in converting atrial fibrillation to sinus rhythm, preventing recurrences of paroxysmal atrial fibrillation, and maintaining sinus rhythm following successful cardioversion of chronic atrial fibrillation. [10][11][12][13] However, there are only a few studies that address the efficacy of propafenone in the prevention of atrial fibrillation and other atrial tachyarrhythmias following cardiac surgery. In an earlier study, prophylactic administration of propafenone did not reduce the incidence of atrial tachyarrhythmias following cardiac surgery, as compared with atenolol.…”

Familial And Acquired Long QT Syndrome And The Cardiac Rapid Delayed Rectifier Potassium Current

“… 74,75 In addition to quinidine ( vide supra ), disopyramide 76,77 and propafenone can also affect the QT interval and I Kr . 78,79 For disopyramide, the QT prolongation may be isomer specific. 77 …”

Effects of propafenone and 5‐hydroxy‐propafenone on hKv1.5 channels

“…Propafenone is a class Ic antiarrhythmic agent used to maintain sinus rhythm in patients with supraventricular tachycardias and in the treatment of ventricular tachycardia (Funck‐Brentano et al , 1990; Bryson et al , 1993; Kishore & Camm, 1995; UK Propafenone PSVT Study Group, 1995). In addition to its blocking properties of cardiac Na + channels, propafenone also blocks L‐type Ca 2+ current ( I Ca ) (Delgado et al , 1993; Fei et al , 1993) and transient outward ( I To ), rapid and slow delayed rectifiers ( I Kr and I Ks , respectively) and inward rectifier ( I Kl ) potassium currents (Duan et al , 1993; Slawsky & Castle, 1994; Delpón et al , 1995).…”