Revisiting propafenone toxicity.

BMJ Case Rep

Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, Florida, USA.

Published: April 2017

Propafenone is a Vaughan Williams class 1c antiarrhythmic medication widely used for treatment of arrhythmias. Although the long-term safety of propafenone use has not been established, it is commonly used for treatment of atrial fibrillation in patients with no structural heart disease. Propafenone is well known as treatment for its effect in terminating paroxysmal episodes of atrial fibrillation. Herein, we discuss an unusual adverse reaction to propafenone in a patient who presented with symptomatic bradycardia and hypotension. The aim of this article is to increase physician awareness for propafenone toxicity and its management, with a focused literature review on propafenone pharmacotherapy.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534703PMC
http://dx.doi.org/10.1136/bcr-2017-219270DOI Listing

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Article Synopsis
  • Propafenone is a class 1C antiarrhythmic medication commonly used to treat atrial fibrillation, but its toxicity, though rare, can be serious and lead to complications like hypotension and cardiac arrest.
  • An 80-year-old male patient experienced symptoms caused by dehydration from excessive diuresis, resulting in serious changes on his ECG that were linked to propafenone toxicity.
  • Managing the patient's fluid levels and temporarily stopping propafenone led to quick improvement in his heart rhythm, highlighting the need to consider factors like volume status when dealing with propafenone toxicity.
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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.

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The current guidelines state that propafenone can be used in combination with a beta-blocker or a calcium channel blocker for pharmacologic cardioversion of recent-onset atrial fibrillation in patients without structural heart disease. To prevent the conversion from atrial fibrillation to atrial flutter with a rapid ventricular rate, it is recommended to administer propafenone following the administration of a beta-blocker or a calcium channel blocker. However, this combination carries the potential risk of cardiogenic shock.

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