The Effect of Propafenone on Premature Ventricular Contractions (PVC). An Analysis Based on Heart Rate Dependency of PVCs.

Abstract

SUMMARYThe effect of 450 mg/day propafenone for two weeks on premature ventricular contractions (PVCs) was studied in combination with an assessment of heart rate (HR) dependency of PVCs using Holter ECG monitoring in patients with more than 720 PVCs per day. The PVC-HR correlation was classified into positive (P), bidirectional (B), and flat and negative (FN) correlation groups. The positive group included only patients in whom PVC frequency increased with a heart rate increase, while the bidirectional group included patients with PVCs whose frequency increased at low heart rates and decreased at high heart rates. The FN group contained both flat (PVC frequency was almost fixed regardless of heart rate changes) and negative (PVC frequency decreased as heart rate increased) correlations. The effectiveness of propafenone was 70% in the positive group and 50% in the nonpositive group which included both bidirectional (67%) and FN (0%) groups, using a > 70% PVC reduction as a criterion of efficacy. From this, we concluded that propafenone is effective in patients showing either positive or bidirectional PVC-HR correlation. The coupling interval (CI) of PVCs was also prolonged by propafenone as a whole. The present study suggests that there are differences in the mechanism of PVC development in patients with flat or negative correlation and those with a positive or bidirectional correlation. Thus, this type of analysis contributes to an understanding of the action of antiarrhythmic agents, and may allow the prediction of their efficacy on PVCs. (Jpn Heart J 2001; 42: 701-711)

The Prevalence and Prognostic Value of Rest Premature Ventricular Contractions

“…Another study suggested that beta-blockers were most effective in reducing PVC frequency in the tachycardia and indifferent groups (Pitzalis et al, 1996). Propafenone has also been shown to be most effective in tachycardia-enhanced patients (Saikawa et al, 2001). …”

Elimination of Benign Ventricular Premature Beats or Ventricular Tachycardia with Catheter Ablation versus Two Different Optimal Antiarrhythmic Drug Treatment Regimens (Sotalol or Verapamil/Flecainide)

“…Sodium channel blockers have a class I (level of evidence C) recommendation in symptomatic patients with VA in the absence of underlying structural heart disease [15]. Class Ic antiarrhythmic drugs (AAD; e.g., propafenone and flecainide) are very effective, with up to 80% VA burden reduction in 50–74% of patients, and they are relatively well tolerated by the patient [6, 16, 17]. However, these agents have led to increased mortality in patients with structural heart disease and, hitherto, a thorough analysis in structurally normal hearts is lacking; therefore, caution is advised.…”