Remarkably Widened QRS Complex Following a Lethal Dose of Propafenone—An Ominous Sign

Li, Jing-Xiu; Wang, Mu-Qiu; Gao, Min

doi:10.1001/jamainternmed.2022.3367

Cited by 3 publications

(2 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Gastrointestinal decontamination, activated charcoal, whole bowel irrigation, multidose activated charcoal, urine alkalization, extracorporeal removal, antidotes and ancillary support serve as useful tools for the decontamination and elimination of drugs from the body [43,44]. In six cases, treatment for PPF intoxication was successful when PPF was taken solely [14,16,35,45,46]. Early gastric lavage with activated charcoal, ionotropic drugs, mechanical cardiopulmonary devices, extracorporeal cardiopulmonary resuscitation, blood purification, aggressive supportive treatments and sodium bicarbonate were administered and seemed crucial to the successful treatment.…”

Section: Discussionmentioning

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

Section: Discussionmentioning

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

show abstract

“…However, flecainide-induced widened QRS complex can contribute to hemodynamic instability at lower heart rates . Given that the widened QRS complex induced by this class Ic antiarrhythmic drug is among the most life-threatening electrocardiography warning indicators (regardless of heart rate), what matters most is to manage flecainide toxicity. The discontinuation of flecainide and sodium bicarbonate therapy has been proposed as a treatment for sodium channel blocker toxicity …”

mentioning

confidence: 99%

Flecainide-Associated QRS Complex Widening—What Really Matters

Dong

Tang

2023

JAMA Intern Med

View full text Add to dashboard Cite

To the Editor: We read with great interest the recent case report by Dr Lopez Perales and colleagues 1 of a patient with electrocardiogram (ECG) findings that showed flecainideassociated 2:1 atrial flutter with widening QRS complex. The case is excellently presented; however, some points require further discussion.Although the authors claim that flecainide-associated QRS widening is induced by RR cycle variations, 1 no association between the onset of wide QRS complex tachycardia and RR cycle variations was observed in Figure 2. 1 Rate-dependence of flecainide-associated QRS complex widening would be proven only by an ECG performed immediately after electrical cardioversion. Also, flecainide-associated widening of QRS complex is a manifestation of flecainide intoxication. Flecainide has a narrow therapeutic index (0.2-1.0 μg/mL), which suggests the possibility of drug-related toxic effects. Some patients develop adverse effects at serum levels greater than 0.7 μg/mL. 2 Although electrical cardioversion can terminate tachycardia, it may not stabilize the hemodynamics if QRS intervals are prolonged.Dr Lopez Perales and colleagues 1 did not specify whether the extended QRS complex was shortened after electrical cardioversion. However, flecainide-induced widened QRS complex can contribute to hemodynamic instability at lower heart rates. 3 Given that the widened QRS complex induced by this class Ic antiarrhythmic drug is among the most lifethreatening electrocardiography warning indicators (regardless of heart rate), 4 what matters most is to manage flecainide toxicity. The discontinuation of flecainide and sodium bicarbonate therapy has been proposed as a treatment for sodium channel blocker toxicity. 5 In addition to those mentioned by the authors, 1 several other methods can help in the differential diagnosis of flecainide-induced tachycardia reported for this case. For example, right bundle-branch block morphology with QRS complex of 200 or fewer milliseconds, left bundle-branch block morphology with QRS complex of 200 or more milliseconds, or a heart rate out of proportion with the degree of hemodynamic instability. 3

show abstract

Propafenone

2022

Reactions Weekly

View full text Add to dashboard Cite

Remarkably Widened QRS Complex Following a Lethal Dose of Propafenone—An Ominous Sign

Abstract: This case report describes the electrocardiogram findings of a patient in their 30s who attempted suicide by taking propafenone and presented to the emergency department with impaired consciousness and convulsions.

Cited by 3 publications

References 7 publications

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

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

Flecainide-Associated QRS Complex Widening—What Really Matters

Propafenone

Contact Info

Product

Resources

About