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Propafenone in Wolff-Parkinson-White syndrome at risk
V Santinelli1, P Turco, M De Paola
1Department of Cardiology and Cardiac Surgery, University of Naples, Italy.
Abstract:
We present our experience on the efficacy of propafenone in ten symptomatic patients with Wolff-Parkinson-White syndrome. The symptoms were dizziness in seven patients and syncope in three patients. While experiencing the symptoms, three of them presented an episode of atrial fibrillation, the shortest preexcited RR intervals being 140, 190, and 200 ms. In the other seven patients, the ECG was not recorded during the symptoms, but an episode of atrial fibrillation was subsequently induced by transesophageal pacing. The shortest preexcited RR intervals during induced atrial fibrillation were 180, 200, 270, 240, 230, 250, and 200 ms. Seven patients had both atrial fibrillation and supraventricular tachycardia. Propafenone (1-2 mg/kg) administered IV in only the patients with sustained atrial fibrillation (spontaneous in two and induced in one patient) prolonged the shortest preexcited RR intervals from 190, 200, and 180 ms to 340, 335, and 340 ms. In the other seven patients, propafenone was not given IV because atrial fibrillation rapidly deteriorated into ventricular fibrillation (one patient) or spontaneously reverted within 1-2 minutes to sinus rhythm (six patients). After oral propafenone, serial trans-esophageal pacing studies reinduced atrial fibrillation in 4 of 6 patients (the shortest preexcited RR intervals increased from 190, 180, 200, and 270 ms to 420, 320, 340, and 380 ms); only in one patient was it possible after propafenone to induce an atrial flutter without preexcitation. After propafenone therapy in 4 of 7 patients, supraventricular tachycardia was not inducible.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Propafenone effectively managed symptoms in Wolff-Parkinson-White syndrome patients by prolonging pre-excited intervals during atrial fibrillation. This antiarrhythmic drug demonstrated efficacy in preventing tachycardia episodes.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Wolff-Parkinson-White syndrome is characterized by accessory electrical pathways causing tachyarrhythmias.
- Symptomatic presentations include dizziness and syncope, often associated with atrial fibrillation.
Purpose of the Study:
- To evaluate the efficacy of propafenone in managing symptomatic Wolff-Parkinson-White syndrome.
- To assess propafenone's effect on electrophysiological parameters during atrial fibrillation and supraventricular tachycardia.
Main Methods:
- Ten symptomatic patients with Wolff-Parkinson-White syndrome were studied.
- Intravenous and oral propafenone administration was assessed, with electrophysiological studies including transesophageal pacing.
Main Results:
- Intravenous propafenone prolonged shortest preexcited RR intervals during atrial fibrillation from 180-200 ms to 335-340 ms in three patients.
- Oral propafenone increased shortest preexcited RR intervals in four of six patients and rendered supraventricular tachycardia non-inducible in four of seven patients.
- Atrial fibrillation rapidly deteriorated to ventricular fibrillation in one patient and spontaneously reverted in six others, limiting IV propafenone use.
Conclusions:
- Propafenone demonstrates efficacy in prolonging refractory periods of accessory pathways, thereby managing tachyarrhythmias in Wolff-Parkinson-White syndrome.
- The drug's effectiveness in preventing inducible arrhythmias suggests a therapeutic role in selected patients.