Oral Loading Dose Of Propafenone Research Articles

Propafenone Versus Vernakalant for Conversion of Recent‐Onset Atrial Fibrillation

An oral loading dose of propafenone 600mg is used in our center as in other places around the world for conversion of recent-onset atrial fibrillation (AF) in patients without structural heart disease. Vernakalant is a novel, safe, and effective drug used intravenously and has proved to be more rapid in converting recent-onset AF to sinus rhythm compared with placebo and amiodarone. There is no study that compares vernakalant with propafenone. The aim of our study is to compare the time taken for conversion of recent-onset AF in patients treated with vernakalant and propafenone. Thirty-six hemodynamically stable patients with recent-onset AF without structural heart disease were prospectively included. A single oral dose of propafenone 600mg was administered to 19 patients and 17 received intravenous vernakalant. Clinical and laboratory variables, conversion rate, and time to conversion were recorded. Baseline characteristics were similar in both groups. Time to conversion to sinus rhythm was of 166min (120-300) in the propafenone group versus 9min (6-18) in the vernakalant group (P=0.0001). Conversion rate was of 78% in the propafenone group at 8h and of 93% in the vernakalant group at 2h; yet, this difference was not statistically significant (P=0.4). Time to conversion had a direct impact in hospital stay, which was 43% shorter in the vernakalant group (P=0.0001). Time to conversion of AF to sinus rhythm was significantly shorter in the vernakalant group compared with the propafenone group and was associated with shorter hospital stay.

Abstract 136: Changes of Myocardial Contractility in Hypertensive Patients With Persistent Atrial Fibrillation Receiving Propafenone

Objective: To study the effect of propafenone 450 mg daily on myocardial contractility in hypertensive patients with persistent atrial fibrillation (AF). METHODS: Study included 32 hypertensive patients with persistent AF, aged from 39 to 63 years (median age 58,6±5,3 years), 14 of them (44%) were men and 18 (56%) were women. Sinus rhythm was restored within 24 hours after the oral loading dose of propafenone 600 mg in all the patients. All the patients received propafenone 450 mg daily to prevent AF paroxysms during the next 12 months. Planar equilibrium radionuclide ventriculography was performed in all the patients to assess myocardial function. Initial study was performed in 32 (100%) patients within the first 3 days after sinus rhythm restoration, the follow-up imaging study was carried out in 18 (56%) patients with sustained sinus rhythm after 12 months. Results: After 12 months of treatment with propafenone, 18 (56%) of hypertensive patients remained in sinus rhythm. Recurrent episodes of AF were registered in 14 (44%) patients during 12 month follow-up period, hence they were excluded from the study. Initial radionuclide ventriculography made after sinus rhythm restoration in hypertensive patients with persistent AF demonstrated myocardial diastolic dysfunction manifested as significant decrease of time to 30% filling and peak LV and RV filling rate. Follow-up study after propafenone treatment during 12 months revealed significant increase in time to 30% filling and peak LV and RV filling rate. Normal values of atrial contribution to left and right ventricular filling were observed in patients maintaining sinus rhythm during 12 month treatment period with propafenone (p<0.05). Systolic parameters and volume of both ventricles remained normal and showed no significant changes. Left and right ventricular ejection fraction before the treatment start and after propafenone administration during 12 months remained within the normal range. Conclusion: Propafenone 450 mg daily administered for recurrent AF prevention does not affect left and right ventricular contractility. Sinus rhythm maintenance for 12 months in hypertensive patients with persistent AF restores atrial contractility and improves ventricular diastolic function.

The value of plasma NT-proBNP levels inpredicting the effect of drug conversion for paroxysmal atrial fibrillation

ObjectiveTo investigate the value of plasma NT-proBNP levels in predicting the effect of drug conversion for paroxysmal atrial fibrillation.MethodThe 132 patients with non-valvular paroxysmalatrial fibrillation were treated by oral loading...

Transient syncope, left bundle branch block and first degree atrioventricular block after “pill-in-the-pocket” administration

The single oral loading dose of propafenone appears to be highly effective for conversion of recent-onset atrial fibrillation (AF), with a relatively rapid effect within 2 to 3 h and freedom from serious adverse effects [1]. Administration of flecainide, dofetilide, propafenone, or ibutilide is recommended for pharmacological cardioversion of AF (Class I Level of Evidence: A). A single oral bolus dose of propafenone or flecainide (“pill-in-the-pocket”) can be administered to terminate persistent AF outside the hospital once treatment has proved safe in hospital for selected patients without sinus or atrioventricular (AV) node dysfunction, bundle-branch block, QT-interval prolongation, the Brugada syndrome, or structural heart disease.

Single oral loading dose of propafenone for pharmacological cardioversion of recent-onset atrial fibrillation

Single oral loading dose of propafenone for pharmacological cardioversion of recent-onset atrial fibrillation

Single oral loading dose of propafenone for pharmacological cardioversion of recent-onset atrial fibrillation

The efficacy and safety of the single dose oral loading regimen of propafenone for pharmacological cardioversion of recent-onset atrial fibrillation (AFib) was evaluated by analyzing the trials on the subject identified through a comprehensive literature search. Most of the trials used a single dose of 600 mg for oral loading. The success rates ranged from 56% to 83%, depending on the duration of AFib and follow-up after drug administration. The conversion time ranged from 110 ± 59 to 287 ± 352 min, depending on the duration of observation after drug administration. The single dose oral loading regimen of propafenone was significantly more efficacious than placebo in the first 8 h after administration but not at 24 h. Compared with the intravenous regimen, the oral regimen resulted in fewer conversions in the first 2 h, but both regimens were equally efficacious afterward. The oral propafenone regimen was as efficacious as the single dose oral loading regimen of flecainide but was superior to those of quinidine and amiodarone. The adverse effects reported were transient arrhythmia, reversible QRS-complex widening, transient hypotension and mild noncardiac side effects. The transient arrhythmias were chiefly at the time of conversion and included appearance of atrial flutter, bradycardia, pauses and junctional rhythm. No life-threatening proarrhythmic adverse effects were reported. The single oral loading dose of propafenone appears to be highly effective for conversion of recent-onset AFib, with a relatively rapid effect within 2 to 3 h and freedom from serious adverse effects.

Comparison of oral loading dose of propafenone and amiodarone for converting recent-onset atrial fibrillation

In patients with recent-onset atrial fibrillation (AF), restoration of sinus rhythm is considered to be the first-line therapeutic option. Although this conversion might be obtained by direct-current shock or intravenous antiarrhythmic drugs, administration of an oral loading dose of class I or III antiarrhythmic drugs is more simple and convenient. This prospective, randomized, multicenter study compares the time to conversion to sinus rhythm obtained with an oral loading dose of propafenone or amiodarone. Patients with recent-onset AF (<2 weeks), without contraindications for the 2 drugs, were randomly assigned to be treated with propafenone (600 mg for the first 24 hours and if necessary a repeated dose of 300 mg for 24 hours) or amiodarone (30 mg/kg for the first 24 hours and if necessary a repeated dose of 15 mg/kg for 24 hours). Exact conversion time during the first 24 hours was determined by Holter monitoring. In each treatment group 43 patients with the same baseline characteristics were included. The median time for restoration of sinus rhythm was shorter (p = 0.05) in the propafenone (2.4 hours) than in the amiodarone (6.9 hours) group. After 24 hours (56% in the propofenone and 47% in the amiodarone group) and 48 hours, the same proportion of patients in the 2 groups recovered sinus rhythm (no serious adverse events were noticed). Thus, oral loading dose of propafenone or amiodarone was safe with a similar conversion rate of recent-onset AF. Propafenone had a faster action.

Safety of oral propafenone in the conversion of recent onset atrial fibrillation to sinus rhythm:: A prospective parallel placebo-controlled multicentre study

Aim: Oral propafenone is effective in restoring sinus rhythm however the proarrhythmic effects are still unknown. The Safety Antiarrhythmic Therapy Evaluation (SATE) trial was a prospective randomized placebo-controlled multicentre study which evaluated the safety of acute oral loading dose of propafenone in patients with recent onset atrial fibrillation. Secondary end-points were to evaluate the effect of digitalis added to propafenone in ventricular rate control and the efficacy of propafenone alone or added to digitalis compared with efficacy of digitalis plus quinidine. Methods and results: 246 patients (126 male; 58±11 years) with atrial fibrillation of <48 h duration were randomly allocated to one of four groups: digitalis 0.75–1 mg i.v. plus quinidine 1100 mg (D+Q, 70 patients); propafenone 450–600 mg orally (PNF, 66 patients); propafenone 450–600 mg orally plus digitalis 0.750–1 mg i.v. (PNF+D, 70 patients); placebo (Pl, 40 patients). All patients underwent 24-h ECG Holter monitoring. Safety was assessed by evaluating the appearance of adverse events classified as mild, moderate and severe. No severe adverse events were reported. Short lasting asymptomatic atrial flutter episodes with atrio–ventricular conduction ≥2:1 were observed in 14% of the D+Q group, 21% PNF, 18% PNF+D and in 8% Pl. One patient in the D+Q group and four in the PNF+D group showed asymptomatic runs of 3–4 ventricular ectopic beats. Reversible sinus atrial blocks (<3 s) were detected in two patients of the D+Q group and in two of the PNF group. In patients with persistent atrial fibrillation the ventricular rate was similar in the four study groups. At 3 h the high efficacy of propafenone was confirmed. At the 24th hour no differences were found between active treatment and placebo arms. Conclusion: Propafenone in a single oral loading dose is safe and promptly effective in patients with recent onset atrial fibrillation.

Predictors of success in the conversion of new-onset atrial fibrillation using oral propafenone

We have investigated the relationship of clinical variables to successful cardioversion of atrial fibrillation (AF) to sinus rhythm using an oral loading dose of propafenone. Fifty consecutive patients with recent onset (< 72 hours) atrial fibrillation of various aetiologies were included in the study cohort. All patients were given the study medication while in the emergency department and then monitored for 8 hours. All patients converting to sinus rhythm (39 out of 50, 78%) were discharged and re-evaluated at 24 hours and 30 days. We investigated the effect of clinical factors such as age, sex, presence of hypertension (HT), chronic obstructive lung disease (COPD), diabetes mellitus (DM), mitral stenosis (MS), congestive heart failure (CHF), coronary artery disease (CAD) and the duration of atrial fibrillation on conversion to sinus rhythm. Of these factors, univariate and multivariate analysis showed that only the duration of atrial fibrillation was a significant predictor of conversion (p = 0.002). Our results suggest that most patients with new-onset AF can be converted successfully to sinus rhythm with a low incidence of adverse reactions using oral propafenone in the emergency department.

Comparison of oral loading dose of propafenone versus amiodarone in converting recent onset atrial fibrillation to sinus rhythm

Comparison of oral loading dose of propafenone versus amiodarone in converting recent onset atrial fibrillation to sinus rhythm

Conversion of recent onset atrial fibrillation to sinus rhythm using a single oral loading dose of propafenone: comparison of two regimens

A population of 105 patients with recent onset (<72 h) atrial fibrillation was randomly treated with propafenone as a single oral loading dose of 450 mg (Regimen A) or 600 mg (Regimen B) or with placebo. A 24-h Holter was performed. Criteria of efficacy were conversion to sinus rhythm at 2, 4 and 8 h compared to placebo and also significant reduction of mean ventricular rate in persistent atrial fibrillation. After 2 h, regimen B was more effective than either regimen A (43% vs. 8%; p=0.001) or placebo (11%; p=0.004). At 4 h, both the active treatments were more effective than placebo (17% vs. 46% regimen A and 57% vs. regimen B; p<0.04 and p<0.001, respectively). Sinus rhythm resumed within 24 h in 71%, 80% and 69% of the patients with regimen A, B and placebo, respectively ( p=not significant). The mean ventricular rate reduction after 1 h was 8%, 11% and 4% for regimen A, B and placebo, respectively ( p<0.005 vs. regimen B), and 17%, 25% and 6% respectively ( p<0.001 placebo vs. regimen A and B, p<0.05 regimen B vs. A) at 2 h. No major adverse effect occurred. Atrial flutter with 1:1 atrioventricular conduction ensued only in one case who received placebo. Propafenone acute oral administration is more effective than placebo in rapidly converting recent-onset atrial fibrillation to sinus rhythm and may be the treatment of choice in this setting limiting hospitalization and contributing to improved quality of life.

911-38 Effect of Single Loading Oral Propafenone or Digoxin in Recent Onset Atrial Fibrillation: Conversion to Sinus Rhythm and Modulation of Ventricular Rate. A Randomized, Placebo Controlled Study

A population of 105 patients (pts) with recent onset (&lt; 72 hours) atrial fibrillation (AF) without clinical signs of heart failure were randomly treated with a single loading oral dose of propafenone (PFN) (600 mg) or digoxin (DIG) (1 mg) or with placebo (PLA). A 24-hour holter monitoring was performed and conversion to sinus rhythm (SR) after 2, 4 and 24 hours was considered as criterion of efficacy. We also evaluated the effect on mean ventricular rate (MVR) in those pts with still lasting AF four hours after drug administration. The 3 groups were comparable as to gender, age, etiology, duration of AF, mean ventricular rate at baseline and left atrial dimension. Conversion to SR PFN (n = 36) DIG (n = 34) PLA (n = 35) p value after 2 hours 16 (44%) 5 (15%) 7 (20%) 0.011 after 4 hours 25 (69%) 11 (32%) 12 (34%) 0.002 after 24 hours 30 (83%) 24 (71%) 25 (71%) ns Mean conversion time within 4 hours was 139 ± 117’ for PFN, 123 ± 66’ for DIG and 116 ± 78’ for PLA (p = ns). Reduction MVR PFN (n = 11) DIG (n = 23) PLA (n = 23) p value baseline (bpm) 134 ± 20 133 ± 29 136 ± 28 † ; ‡ &lt; 0.001 after 2 hours 106 ± 22 † 113 ± 32 ‡ 124 ± 29 vs baseline (-21%) ** (1-15%) (-9%) ** * = 0.002 after 4 hours 92 ± 15 † 104 ± 29 ‡ 121 ± 27 °° &lt; 0.01 (-31%) °/* (-22%) °/°° (-11%) */°° °; ** &lt; 0.05 No serious adverse effects were noted in either group. Phases of regular tachycardia were observed in 3 pts of each group, but only in 2 cases, both receiving placebo, 1: 1 AV conduction ensued. 1) Oral loading dose of PFN is safely and promptly efficacious in converting recent onset AF to SR. 2) The efficacy of oral PFN is significantly superior in comparison to oral DIG while oral loading dose of DIG is no better than placebo. 3) PFN and DIG are both effective in reducing MVR in pts with recentonset AF who did not revert to SR or who reverted late after drug administration.

Conversion of recent-onset atrial fibrillation by a single oral loading dose of propafenone or flecainide

Conversion of recent-onset atrial fibrillation by a single oral loading dose of propafenone or flecainide