Journal Article

Utility of adjunctive single oral bolus propafenone therapy in patients with atrial defibrillators

David Schwartzman, Mark N. Harvey, Robert H. Hoyt, Jodi L. Koehler, Michael R. Ujhelyi and David E. Euler

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 8, issue 3, pages 211-215
Published in print March 2006 | ISSN: 1099-5129
Published online February 2006 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1093/europace/euj051
Utility of adjunctive single oral bolus propafenone therapy in patients with atrial defibrillators

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Aims Previous studies have demonstrated that ambulatory atrial defibrillation shocks delivered by an implantable cardioverter-defibrillator (ICD) are safe and effective, but poorly tolerated. Separate studies have demonstrated the utility of single oral bolus propafenone for conversion of recent-onset atrial fibrillation (AF); however, most patients were hospitalized, had no structural heart disease, were taking no other antiarrhythmic drugs, and were not exposed to concomitant shock. We hypothesized that a single oral bolus dose of propafenone given early after onset would be a safe and effective adjunct to ICD-based AF therapy and improve overall therapy tolerance.

Methods and results A randomized three-way crossover study design was used to compare three strategies, deployed in the ambulatory setting early after AF episode onset in 35 ICD patients with advanced, drug refractory episodic/persistent syndromes, many of whom had structural heart disease and were taking other antiarrhythmic drugs: (i) single oral bolus propafenone (600 mg), followed by ICD shock if necessary; (ii) single oral bolus placebo, followed by ICD shock if necessary; and (iii) no oral bolus therapy and ICD shock if necessary (no bolus). Antiarrhythmic efficacy, defined by the restoration of sinus rhythm within 24 h, was similar during propafenone (81%) and no-bolus strategies (84%); both were significantly higher than during placebo strategy (62%). Propafenone was well tolerated and not associated with proarrhythmia. Shock use was significantly lower during propafenone strategy (19%) than during no-bolus strategy (55%); this was correlated with improved patient tolerance.

Conclusion Adjunctive use of single oral bolus propafenone is safe and effective in patients with an ICD and improves patient tolerance of device-based AF therapy.

Keywords: Atrial fibrillation; Antiarrhythmic drug; Implantable cardioverter-defibrillator; Atrial defibrillator; Pacing

Journal Article.  2872 words. 

Subjects: Cardiovascular Medicine

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