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Sixty-six episodes of ventricular fibrillation within four hours: electrical stability restored by propafenone
P Bellone1, P Spirito, C Vecchio
1Divisione di Cardiologia, Ente Ospedaliero Ospedali Galliera, Genoa, Italy.
Insights
This case study highlights a patient experiencing frequent ventricular fibrillation after a heart attack. Propafenone boluses and infusion proved effective when lidocaine and amiodarone failed.
Area of Science:
- Cardiology
- Clinical Electrophysiology
Background:
- Ventricular fibrillation (VF) is a critical complication in acute myocardial infarction (AMI) patients.
- Intravenous lidocaine is typically the first-line antiarrhythmic for recurrent VF in AMI.
Observation:
- A patient with recent anterior myocardial infarction experienced an exceptionally high frequency of VF episodes (66 in 4 hours).
- Standard treatment with intravenous lidocaine and amiodarone failed to prevent VF recurrences.
Findings:
- Two separate boluses of propafenone significantly reduced the rate of VF recurrence.
- Continuous propafenone infusion successfully controlled the arrhythmia, preventing further episodes.
Implications:
- Propafenone may be a valuable therapeutic option for refractory ventricular fibrillation in acute myocardial infarction.
- Combined antiarrhythmic therapy including propafenone might be necessary for complex cases.
Abstract:
Ventricular fibrillation is a complication in patients hospitalized for acute myocardial infarction. We report the case of an unusually high number of episodes of ventricular fibrillation (66 episodes) that occurred within a period of 4 h in a patient with recent anterior myocardial infarction. In patients with acute or recent myocardial infarction and recurrent episodes of ventricular fibrillation, intravenous lidocaine is the antiarrhythmic medication of choice. In our patient, recurrences of ventricular fibrillation were not prevented either by lidocaine, or amiodarone. The rate of recurrence of ventricular fibrillation, however, decreased dramatically, twice, in the minutes following two separate boluses of propafenone, and the arrhythmia did not recur when continuous infusion of propafenone was started. We cannot exclude that were the combined antiarrhythmic effects of lidocaine, amiodarone and propafenone that led to the final control of the arrhythmia.