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Normal left ventricular function does not protect against propafenone-induced incessant ventricular tachycardia
R N Millar1, J B Lawrenson, D A Milne
1Department of Medicine, Groote Schuur Hospital.
Summary
Propafenone, a class Ic anti-arrhythmic, can provoke dangerous, incessant ventricular tachycardia even in patients with normal heart function. Caution is advised due to its potential to worsen arrhythmias.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Propafenone, a class Ic anti-arrhythmic with mild beta-blocking effects, is now available.
- Its use in patients with ventricular tachycardia (VT) not caused by ischemic heart disease is explored.
Observation:
- Three patients with normal left ventricular function and VT were treated with propafenone.
- Two patients with arrhythmogenic right ventricular dysplasia experienced incessant monomorphic VT, lasting over 24 hours, despite interventions.
Findings:
- Propafenone induced VT with slower rates and broader QRS complexes, indicating impaired intraventricular conduction.
- This suggests re-entry perpetuation due to drug-induced conduction slowing.
Implications:
- Patients with normal left ventricular function are also at risk for propafenone-induced arrhythmias, especially with underlying substrates for re-entry.
- Propafenone, like other potent anti-arrhythmics, requires cautious use due to the risk of life-threatening arrhythmias.