Long-term follow-up of patients with inducible supraventricular tachycardia treated with flecainide or propafenone: Therapy guided by transesophageal electropharmacologic testing

Furlanello, F; Guarnerio, M; Inama, Giuseppe; Vergara, Giuseppe; Greco, Maurizio Del; Bertoldi, A.; Dallago, Michele

doi:10.1016/0002-9149(92)91073-d

Cited by 3 publications

(2 citation statements)

References 6 publications

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“…RF ablation therapy is increasingly used in pediatric patients with SVTs, however, antiarrhythmic therapy is still the first choice (usually guided on the results of transesophageal atrial pacing technique), in which propafenone is one of the first choices and has good efficacy in termination of tachycardias (32,33). All this points to the importance of antiarrhythmics for the treatment of supraventricular tachycardias, and therefore to the importance of propafenone, which has proven to be efficient in our study as well as several previous studies, although they included a small number of patients (23,27,28). According to the literature overview, indication for continuous antiarrhythmic therapy is non-inducibility of tachycardia after antiarrhythmic agent administration (15,17,18).…”

Section: Discussionsupporting

confidence: 56%

“…Furlanello et al performed transesophageal EPS in 58 patients, with administration of class Ic antiarrhythmics (propafenone and flecainide) (27). Their study showed that these medications were extremely effective in the prevention of supraventricular tachycardias, if arrhythmia was non-inducible during the EPS after the drug application, with effectiveness of prevention of 65.5%, which is less than in our study (81.8%).…”

Section: Discussionmentioning

confidence: 99%

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Electrophysiological predictors of propafenone efficacy in prevention of atrioventricular nodal re-entrant and atrioventricular re-entrant tachycardia

Pintarić

Zeljković²,

Babić³

et al. 2012

Croat Med J

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AimTo assess the efficacy of propafenone in prevention of atrioventricular nodal reentrant tachycardia (AVNRT) and orthodromic atrioventricular tachycardia (AVRT) based on the clinical results of arrhythmia recurrence and find the electrophysiological predictor of propafenone effectiveness.MethodsThis retrospective study included 44 participants in a 12-month period, who were divided in two groups: group A – in which propafenone caused complete ventriculo-atrial block and group B – in which propafenone did not cause complete ventriculo-atrial block.ResultsGroup A had significantly lower incidence of tachycardia than group B (95% vs 70.8%, P = 0.038), and complete ventriculo-atrial block predicted the efficacy of propafenone oral therapy in the prevention of tachycardia (sensitivity 87.5%, specificity 52.8%, positive predictive value 95%, negative predictive value 29.2%). Patients with AVNRT in group B who did not experience the recurrences of tachycardia had significantly shorter echo zone before intravenous administration of propafenone than the patients who experienced episodes of sustained tachycardia (median 40 ms [range 15-60 ms] vs 79 ms [range 50-180 ms], P = 0.008).ConclusionIn patients with non-inducible tachycardia, complete ventriculo-atrial block can be used as an electrophysiological predictor of the efficacy of propafenone oral therapy in the prevention of tachycardia. In patients with non-inducible AVNRT, but without complete ventriculo-atrial block, propafenone was more effective in patients with shorter echo zone of tachycardia.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Electrophysiological predictors of propafenone efficacy in prevention of atrioventricular nodal re-entrant and atrioventricular re-entrant tachycardia

Pintarić

Zeljković²,

Babić³

et al. 2012

Croat Med J

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Safety and utility of flecainide acetate in the routine care of patients with supraventricular tachyarrhythmias: Results of a mmulticenter trial

Hopson

Buxton

Rinkenberger

et al. 1996

The American Journal of Cardiology

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Guidelines for the Use of Propafenone in Treating Supraventricular Arrhythmias

Kishore

1995

Drugs

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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.

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Long-term follow-up of patients with inducible supraventricular tachycardia treated with flecainide or propafenone: Therapy guided by transesophageal electropharmacologic testing

Cited by 3 publications

References 6 publications

Electrophysiological predictors of propafenone efficacy in prevention of atrioventricular nodal re-entrant and atrioventricular re-entrant tachycardia

Electrophysiological predictors of propafenone efficacy in prevention of atrioventricular nodal re-entrant and atrioventricular re-entrant tachycardia

Safety and utility of flecainide acetate in the routine care of patients with supraventricular tachyarrhythmias: Results of a mmulticenter trial

Guidelines for the Use of Propafenone in Treating Supraventricular Arrhythmias

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