Skip Navigation



Europace Advance Access published online on February 7, 2006
Europace, doi:10.1093/europace/euj051
This Article
Right arrow Full Text (Rapid PDF)
Right arrow All Versions of this Article:
8/3/211    most recent
euj051v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Schwartzman, D.
Right arrow Articles by Euler, D. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Schwartzman, D.
Right arrow Articles by Euler, D. E.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The European Society of Cardiology 2006. All rights reserved
Received September 1, 2005
Revised November 2, 2005
Accepted November 22, 2005

Article

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

David Schwartzman 1 *, Mark N. Harvey 2, Robert H. Hoyt 3, Jodi L. Koehler 4, Michael R. Ujhelyi 4, and David E. Euler 4

1 University of Pittsburgh, UPMC Presbyterian, B535 Pittsburgh, PA 15213-2582, USA
2 Oklahoma Foundation for Cardiovascular Research, Oklahoma City, OK, USA
3 Iowa Heart Center, Iowa City, IA, USA
4 Medtronic Inc., Minneapolis, MN, USA

* To whom correspondence should be addressed.
David Schwartzman, E-mail: schwartzmand{at}upmc.edu


  Abstract

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.
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?




Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.