Medical therapy with flecainide and propafenone in atrial fibrillation: Long-term clinical experience in the tertiary care setting

Kovacs, Boldizsar; Yakupoglu, Haci Yakup; Eriksson, Urs; Krasniqi, Nazmi; Duru, Fırat

doi:10.5603/cj.a2022.0116

Cited by 5 publications

(5 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…PROP is a class 1c antiarrhythmic drug that blocks the Na+ current and is used to control heart rhythm in patients with atrial fibrillation [25]. The present study is one of the few found in the literature reporting the activity of PROP against strains of Candida spp.…”

Section: Discussionmentioning

confidence: 88%

Antifungal activity of propafenone on Candida spp. strains: interaction with antifungals and possible mechanism of action

Barbosa,

Leitão,

de Oliveira

et al. 2024

Journal of Medical Microbiology

View full text Add to dashboard Cite

Introduction. The development of new antifungal drugs has become a global priority, given the increasing cases of fungal diseases together with the rising resistance to available antifungal drugs. In this scenario, drug repositioning has emerged as an alternative for such development, with advantages such as reduced research time and costs. Gap statement. Propafenone is an antiarrhythmic drug whose antifungal activity is poorly described, being a good candidate for further study. Aim. This study aims to evaluate propafenone activity against different species of Candida spp. to evaluate its combination with standard antifungals, as well as its possible action mechanism. Methodology. To this end, we carried out tests against strains of Candida albicans, Candida auris, Candida parapsilosis, Candida tropicalis, Candida glabrata and Candida krusei based on the evaluation of the MIC, minimum fungicidal concentration and tolerance level, along with checkerboard and flow cytometry tests with clinical strains and cell structure analysis by scanning electron microscopy (SEM). Results. The results showed that propafenone has a 50% MIC ranging from 32 to 256 µg ml−1, with fungicidal activity and positive interactions with itraconazole in 83.3% of the strains evaluated. The effects of the treatments observed by SEM were extensive damage to the cell structure, while flow cytometry revealed the apoptotic potential of propafenone against Candida spp. Conclusion. Taken together, these results indicate that propafenone has the potential for repositioning as an antifungal drug.

show abstract

Section: Discussionmentioning

confidence: 88%

Antifungal activity of propafenone on Candida spp. strains: interaction with antifungals and possible mechanism of action

Barbosa,

Leitão,

de Oliveira

et al. 2024

Journal of Medical Microbiology

View full text Add to dashboard Cite

show abstract

“…Similar to AF treatment, the drugs of first choice for maintaining sinus rhythm are antiarrhythmic class IC, in the absence of structural heart disease, or class III if it is present [ 51 ]. Special caution should be taken with the administration of antiarrhythmic drugs from the IC group, up to 25% may develop typical atrial flutter [ 70 ]. Flecainide and propafenone can slow conduction through atrial tissue more than they prolong refractoriness.…”

Section: Treatmentmentioning

confidence: 99%

“…This condition is known as class IC atrial flutter. Characteristically, its cycle length is greater than spontaneous typical flutter and it can lead 1:1 atrioventricular conduction and thus a significant increase in ventricular response, potentially causing hemodynamic compromise or even ventricular fibrillation [ 70 , 71 ]. Consequently, it is usually recommended to prescribe AV nodal-blocking agents in addition to class IC drugs to reduce this potential risk [ 70 ].…”

Section: Treatmentmentioning

confidence: 99%

Cavotricuspid Isthmus-Dependent Atrial Flutter. Beyond Simple Linear Ablation

Abdala-Lizarraga,

Quesada-Ocete,

Quesada-Ocete

et al. 2024

Rev. Cardiovasc. Med.

View full text Add to dashboard Cite

The demonstration of a peritricuspid circular movement with a zone of slow conduction in the cavotricuspid isthmus, together with the high efficacy of linear ablation and widely accepted acute endpoints, has established typical flutter as a disease with a well-defined physiopathology and treatment. However, certain aspects regarding its deeper physiopathology, ablation targets, and methods for verifying the results remain to be clarified. While current research efforts have primarily been focused on the advancement of effective ablation techniques, it is crucial to continue exploring the intricate electrophysiological, ultrastructural, and pharmacological pathways that underlie the development of atrial flutter. This ongoing investigation is essential for the development of targeted preventive strategies that can act upon the specific mechanisms responsible for the initiation and maintenance of this arrhythmia. In this work, we will discuss less ascertained aspects alongside the most widely recognized general data, as well as the most recent or less commonly used contributions regarding the electrophysiological evaluation and ablation of typical atrial flutter. Regarding electrophysiological characteristics, one of the most intriguing findings is the presence of low voltage zones in some of these patients together with the presence of a functional, unidirectional line of block between the two vena cava. It is theorized that episodes of paroxysmal atrial fibrillation can trigger this line of block, which may then allow the onset of stable atrial flutter. Without this, the patient will either remain in atrial fibrillation or return to sinus rhythm. Another of the most important pending tasks is identifying patients at risk of developing post-ablation atrial fibrillation. Discriminating between individuals who will experience a complete arrhythmia cure and those who will develop atrial fibrillation after flutter ablation, remains essential given the important prognostic and therapeutic implications. From the initial X-ray guided linear cavotricuspid ablation, several alternatives have arisen in the last decade: electrophysiological criteria-directed point applications based on entrainment mapping, applications directed by maximum voltage criteria or by wavefront speed and maximum voltage criteria (omnipolar mapping). Electro-anatomical navigation systems offer substantial support in all three strategies. Finally, the electrophysiological techniques to confirm the success of the procedure are reviewed.

show abstract

“…Zhender et al [8] observed nausea and vomiting at short-term higher therapeutic doses and the exacerbation of ventricular extrasystoles during long-term treatment. Various studies also describe a proarrhythmic adverse effect, such as wide complex tachycardia or QRS broadening [9]; electrocardiogram-associated adverse events (prolonged QRS and QTc, first-and second-degree atrioventricular nodal block, bradycardia); and systematic adverse events (hypotension, dizziness, dysgeusia, fatigue, irritation and gastrointestinal intolerance) [10]. The coadministration of metoprolol and verapamil also increases the risk of toxicity [11,12].…”

Section: Introductionmentioning

confidence: 99%

A Tissue Distribution Study of Propafenone in an Intentional Fatal Poisoning Case

Nižnanská,

Hengerics Szabó,

Masár

et al. 2024

IJMS

View full text Add to dashboard Cite

Propafenone (PPF) belongs to the class 1C antiarrhythmics and can cause electrocardiogram-associated adverse/toxic effects. Cases of PPF intoxication are rarely investigated. We developed a novel and selective GC-MS/MS method for the determination of PPF and its tissue distribution in an intentional fatal poisoning case, which is applicable to PPF quantification in the range of therapeutic to lethal concentrations in complex post-mortem samples. A simple and effective sample pretreatment was applied to all analyzed samples. PPF was determined without the need for dilution, even in highly complex samples containing a wide range of analyte concentrations. Quantification was performed using the standard addition method, developed and validated according to the ICH M10 guidelines. The obtained results indicated that the PPF concentration in the serum from blood taken while alive, before therapy, was the highest ever reported in the literature. Despite the intensive therapy after the patients’ admission, the PPF concentrations in the lungs, spleen, femoral blood and cardiac blood were fatal or abnormally high. On the other hand, the concentrations in the liver and skeletal muscle were lower or approximately the same as observed in cases with therapeutic doses. To the best of our knowledge, the distribution of PPF has not been investigated in fatal intoxication cases and can be helpful in clinical or forensic toxicology.

show abstract

Medical therapy with flecainide and propafenone in atrial fibrillation: Long-term clinical experience in the tertiary care setting

Abstract: This article has been peer reviewed and published immediately upon acceptance.It is an open access article, which means that it can be downloaded, printed, and distributed freely, provided the work is properly cited. Articles in "Cardiology Journal" are listed in PubMed.

Cited by 5 publications

References 28 publications

Antifungal activity of propafenone on Candida spp. strains: interaction with antifungals and possible mechanism of action

Antifungal activity of propafenone on Candida spp. strains: interaction with antifungals and possible mechanism of action

Cavotricuspid Isthmus-Dependent Atrial Flutter. Beyond Simple Linear Ablation

A Tissue Distribution Study of Propafenone in an Intentional Fatal Poisoning Case

Contact Info

Product

Resources

About